ENROLLED
COMMITTEE SUBSTITUTE
FOR
COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 414
(Senators Prezioso, Foster, Jenkins, Stollings,
Caruth, Laird, Unger, Minard and Kessler, original sponsors)
____________
[Passed April 11, 2009; in effect ninety days from passage.]
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AN ACT to repeal §5-16-7b of the Code of West Virginia, 1931, as
amended; to repeal §5A-3C-1, §5A-3C-2, §5A-3C-3, §5A-3C-4,
§5A-3C-5, §5A-3C-6, §5A-3C-7, §5A-3C-8, §5A-3C-9, §5A-3C-10,
§5A-3C-11, §5A-3C-12, §5A-3C-13, §5A-3C-14, §5A-3C-15,
§5A-3C-16 and §5A-3C-17 of said code; to amend and reenact
§5F-2-2 of said code; to amend and reenact §16-29H-1, §16-29H-
2, §16-29H-3, §16-29H-4 and §16-29H-5 of said code; and to
amend said code by adding thereto five new sections,
designated §16-29H-6, §16-29H-7, §16-29H-8, §16-29H-9, and
§16-29H-10, all relating generally to the creation of the
Governor's Office of Health Enhancement and Lifestyle Planning; setting forth legislative findings; setting forth
the powers and duties of the office; transferring the powers
and duties of the Pharmaceutical Cost Management Council to
the office; creating the position of director; setting forth
the qualifications of the director; setting forth the powers
and duties of the director; providing for staff; requiring the
development of a five-year strategic plan; providing for
legislative rule-making authority; providing for coordination
with various state agencies, departments, boards, bureaus and
commissions; requiring reporting to the Governor and the
Legislature; establishing pilot projects for patient-centered
medical homes; setting forth legislative findings; defining
terms; evaluating existing medical home pilot programs;
establishing criteria for pilot projects for patient-centered
medical homes; defining four types of pilot projects; setting
forth evaluation criteria; granting rule-making authority; and
exempting from Purchasing division requirements.
Be it enacted by the Legislature of West Virginia:
That §5-16-7b of the Code of West Virginia,1931, as amended,
be repealed; that §5A-3C-1, §5A-3C-2, §5A-3C-3, §5A-3C-4, §5A-3C-5,
§5A-3C-6, §5A-3C-7, §5A-3C-8, §5A-3C-9, §5A-3C-10, §5A-3C-11, §5A-
3C-12, §5A-3C-13, §5A-3C-14, §5A-3C-15, §5A-3C-16 and §5A-3C-17 of
said code be repealed; that §5F-2-2 of said code be amended and
reenacted; that §16-29H-1, §16-29H-2, §16-29H-3, §16-29H-4 and §16-
29H-5 of said code be amended and reenacted; and that said code be
amended by adding thereto five new sections, designated §16-29H-6, §16-29H-7, §16-29H-8, §16-29H-9 and §16-29-10, all to read as
follows
CHAPTER 5F. ORGANIZATION OF THE EXECUTIVE BRANCH OF STATE
GOVERNMENT.
ARTICLE 2. TRANSFER OF AGENCIES AND BOARDS.
§5F-2-2. Power and authority of secretary of each department.
(a) Notwithstanding any other provision of this code to the
contrary, the secretary of each department shall have plenary power
and authority within and for the department to:
(1) Employ and discharge within the office of the secretary
employees as may be necessary to carry out the functions of the
secretary, which employees shall serve at the will and pleasure of
the secretary;
(2) Cause the various agencies and boards to be operated
effectively, efficiently and economically and develop goals,
objectives, policies and plans that are necessary or desirable for
the effective, efficient and economical operation of the
department;
(3) Eliminate or consolidate positions, other than positions
of administrators or positions of board members and name a person
to fill more than one position;
(4) Transfer permanent state employees between departments in
accordance with the provisions of section seven of this article;
(5) Delegate, assign, transfer or combine responsibilities or
duties to or among employees, other than administrators or board members;
(6) Reorganize internal functions or operations;
(7) Formulate comprehensive budgets for consideration by the
Governor and transfer within the department funds appropriated to
the various agencies of the department which are not expended due
to cost savings resulting from the implementation of the provisions
of this chapter:
Provided, That no more than twenty-five percent of
the funds appropriated to any one agency or board may be
transferred to other agencies or boards within the department:
Provided, however, That no funds may be transferred from a special
revenue account, dedicated account, capital expenditure account or
any other account or funds specifically exempted by the Legislature
from transfer, except that the use of appropriations from the State
Road Fund transferred to the office of the Secretary of the
Department of Transportation is not a use other than the purpose
for which the funds were dedicated and is permitted:
Provided
further, That if the Legislature by subsequent enactment
consolidates agencies, boards or functions, the appropriate
secretary may transfer the funds formerly appropriated to the
agency, board or function in order to implement consolidation. The
authority to transfer funds under this section shall expire on June
30, 2010;
(8) Enter into contracts or agreements requiring the
expenditure of public funds and authorize the expenditure or
obligation of public funds as authorized by law:
Provided, That the
powers granted to the secretary to enter into contracts or agreements and to make expenditures or obligations of public funds
under this provision shall not exceed or be interpreted as
authority to exceed the powers granted by the Legislature to the
various commissioners, directors or board members of the various
departments, agencies or boards that comprise and are incorporated
into each secretary's department under this chapter;
(9) Acquire by lease or purchase property of whatever kind or
character and convey or dispose of any property of whatever kind or
character as authorized by law:
Provided, That the powers granted
to the secretary to lease, purchase, convey or dispose of such
property shall be exercised in accordance with the provisions of
articles three, ten and eleven, chapter five-a of this code:
Provided, however, That the powers granted to the secretary to
lease, purchase, convey or dispose of such property shall not
exceed or be interpreted as authority to exceed the powers granted
by the Legislature to the various commissioners, directors or board
members of the various departments, agencies or boards that
comprise and are incorporated into each secretary's department
under this chapter;
(10) Conduct internal audits;
(11) Supervise internal management;
(12) Promulgate rules, as defined in section two, article one,
chapter twenty-nine-a of this code, to implement and make effective
the powers, authority and duties granted and imposed by the
provisions of this chapter in accordance with the provisions of
chapter twenty-nine-a of this code;
(13) Grant or withhold written consent to the proposal of any
rule, as defined in section two, article one, chapter twenty-nine-a
of this code, by any administrator, agency or board within the
department. Without written consent, no proposal for a rule shall
have any force or effect;
(14) Delegate to administrators the duties of the secretary as
the secretary may deem appropriate, from time to time, to
facilitate execution of the powers, authority and duties delegated
to the secretary; and
(15) Take any other action involving or relating to internal
management not otherwise prohibited by law.
(b) The secretaries of the departments hereby created shall
engage in a comprehensive review of the practices, policies and
operations of the agencies and boards within their departments to
determine the feasibility of cost reductions and increased
efficiency which may be achieved therein, including, but not
limited to, the following:
(1) The elimination, reduction and restriction of the state's
vehicle or other transportation fleet;
(2) The elimination, reduction and restriction of state
government publications, including annual reports, informational
materials and promotional materials;
(3) The termination or rectification of terms contained in
lease agreements between the state and private sector for offices,
equipment and services;
(4) The adoption of appropriate systems for accounting, including consideration of an accrual basis financial accounting
and reporting system;
(5) The adoption of revised procurement practices to
facilitate cost-effective purchasing procedures, including
consideration of means by which domestic businesses may be assisted
to compete for state government purchases; and
(6) The computerization of the functions of the state agencies
and boards.
(c) Notwithstanding the provisions of subsections (a) and (b)
of this section, none of the powers granted to the secretaries
herein shall be exercised by the secretary if to do so would
violate or be inconsistent with the provisions of any federal law
or regulation, any federal-state program or federally delegated
program or jeopardize the approval, existence or funding of any
program.
(d) The layoff and recall rights of employees within the
classified service of the state as provided in subsections (5) and
(6), section ten, article six, chapter twenty-nine of this code
shall be limited to the organizational unit within the agency or
board and within the occupational group established by the
classification and compensation plan for the classified service of
the agency or board in which the employee was employed prior to the
agency or board's transfer or incorporation into the department:
Provided, That the employee shall possess the qualifications
established for the job class. The duration of recall rights
provided in this subsection shall be limited to two years or the length of tenure, whichever is less. Except as provided in this
subsection, nothing contained in this section shall be construed to
abridge the rights of employees within the classified service of
the state as provided in sections ten and ten-a, article six,
chapter twenty-nine of this code.
(e) Notwithstanding any other provision of this code to the
contrary, the secretary of each department with authority over
programs which have an impact on the delivery of health care
services in the state or are payors for health care services or are
payors for prescription drugs, including, but not limited to, the
Public Employees Insurance Agency, the Department of Health and
Human Resources, the Bureau for Senior Services, the Children's
Health Insurance Program, the Health Care Authority, the Office of
the Insurance Commissioner, the Division of Corrections, the
Division of Juvenile Services, the Regional Jail and Correctional
Facility Authority, state colleges and universities, public
hospitals, state or local institutions including nursing homes and
veterans' homes, the Division of Rehabilitation, public health
departments, the Bureau for Medical Services and other programs,
which have an impact on the delivery of health care services or are
payors for health care services or are payors for prescription
drugs, in West Virginia shall cooperate with the Governor's Office
of Health Enhancement and Lifestyle Planning established pursuant
to article twenty-nine-h, chapter sixteen of this code for the
purpose of improving the health care delivery services in West
Virginia for any program over which they have authority.
CHAPTER 16. PUBLIC HEALTH.
ARTICLE 29H. GOVERNOR'S OFFICE OF HEALTH ENHANCEMENT AND
LIFESTYLE PLANNING.
§16-29H-1. Legislative findings.
The Legislature finds:
(1) Rising health care costs have a significant impact not
only on the citizens of the state, but also the state's ability to
develop a competitive advantage in seeking new business. Reducing
this level of costs and developing new, more effective options for
reducing growth in health care spending is essential to ensuring
the health of West Virginia's citizens and to the advancement of a
well-developed workforce.
(2) West Virginia spends thirteen percent more per person on
health care than the national average. Moreover, the growth in
spending in the state is higher than the national average. These
rising costs have contributed to fewer employers, particularly
small employers, offering health insurance as a benefit of
employment. This is an occurrence that may further drive up health
care costs throughout the state.
(3) West Virginia is among the highest in such health care
indicators as childhood and adult obesity which provides a direct
connection to higher rates of diabetes, hypertension,
hyperlipidemia, heart disease, pulmonary disorders and comorbid
depression experienced in West Virginia. Nearly one third of the
rise in health care costs can be attributed to the rise in obesity throughout the state and the nation. Additionally, high rates of
chronic illness represents a substantial reduction in worker
productivity.
(4) To address the concerns over rising costs, West Virginia
must change the way it pays for care, shifting the focus to primary
care and prevention. Seventy-five percent of health care spending
is associated with treatment of chronic diseases requiring ongoing
medical management over time. Patients with chronic diseases,
however, only receive fifty-six percent of the clinically
recommended preventive services. This lack of preventive services
creates a seventy-five percent increase in health care spending.
(5) Health care delivery in West Virginia needs to be
modernized. This will require substantial changes in how health
care is delivered to the chronically ill, an increase in
information technology tools used for patient management, a
simplification of health care processing and a broad overhaul in
our perceptions of wellness and prevention.
(6) West Virginians must be challenged to engage in a more
healthy lifestyle, they must alter the focus of their perception of
health care from one of episodic care to prevention and wellness
efforts. Equally as important, is that healthcare providers must
be engaged with their patients and in the process of delivery of
health care and strive for continuous improvement of the quality of
care they provide.
(7) West Virginia must develop a health care system that is
sufficient to meet the needs of its citizens; equitable, fair and sustainable, but that is also accountable for quality, access, cost
containment and service delivery.
§16-29H-2. Creation of the Governor's Office of Health Enhancement
and Lifestyle Planning; duties.
(a) There is created the Governor's Office of Health
Enhancement and Lifestyle Planning. The purpose of this office is
to coordinate all state health care system reform initiatives among
executive branch agencies, departments, bureaus and offices. The
office shall be under the direct supervision of the director, who
is responsible for the exercise of the duties and powers assigned
to the office under the provisions of this article.
(b) All state agencies that have responsibility for the
development, improvement and implementation of any aspect of West
Virginia's health care system, including, but not limited to, the
Public Employees Insurance Agency, the Bureau for Senior Services,
the Children's Health Insurance Program, Office of the
Pharmaceutical Advocate, the Health Care Authority, the West
Virginia Health Information Network, the Insurance Commission, the
Department of Health and Human Resources, state colleges and
universities, the Pharmaceutical Advocate, public hospitals, state
or local institutions such as nursing homes, veteran's homes, the
Division of Rehabilitation, public health departments, shall
cooperate with the Governor's Office of Health Enhancement and
Lifestyle Planning established for the purpose of coordinating the
health care delivery system in West Virginia for any program over
which they have authority.
§16-29H-3. Director of the Governor's Office of Health Enhancement
and Lifestyle Planning appointment; qualifications;
oath; salary.
(a) The office is under the supervision of the director. The
director is the executive and administrative head of the office and
shall be appointed by the Governor with advice and consent of the
Senate. The director shall be qualified by training and experience
to direct the operations of the Governor's Office of Health
Enhancement and Lifestyle Planning and serves at the will and
pleasure of the Governor. The duties of the director include, but
are not limited to, the management and administration of the
Governor's Office of Health Enhancement and Lifestyle Planning.
(b) The director:
(1) Serves on a full time basis and may not be engaged in any
other profession or occupation;
(2) May not hold political office in the government of the
state either by election or appointment while serving as the
director;
(3) Shall be a citizen of the United States and West Virginia
and become a resident of the state within ninety days of
appointment;
(4) Is ineligible for civil service coverage as provided in
section four, article six, chapter twenty-nine of this code. Any
other employee hired by the director is also ineligible for civil
service coverage.
(c) Before entering upon the discharge of the duties as
director, the director shall take and subscribe to the oath of
office prescribed in section five, article IV of the Constitution
of West Virginia. The executed oath shall be filed in the Office
of the Secretary of State.
§16-29H-4. Director of the Governor's Office of Health Enhancement
and Lifestyle; powers and duties, hiring of staff.
(a) The director has the power and authority to:
(1) Purchase or enter into contracts or agreements as
necessary to achieve the purposes of this article;
(2) File suit;
(3) At the request of a state agency that has responsibility
for any aspect of West Virginia's health care system, evaluate and
advise the agency on ways that can better achieve the purposes of
this article. In addition, the director may determine in
collaboration with the agencies responsible for health systems in
the state to improve efficiencies and reduce costs through
interagency agreements to enter into contracts. Contracts may only
be renegotiated if there is a demonstrated and measurable cost
savings for the state and the agencies are in agreement;
(4) Enter into contracts with public or private entities in
this state, governments of other states and jurisdictions and their
individual departments, agencies, authorities, institutions,
programs, quasi-public corporations and political subdivisions in
the event that such contracts would be a collaboration between the
health system agencies involved and agreed to by all parties.
(5) Participate in regional or multistate purchasing alliances
or consortia, formed for the purpose of pooling the combined
purchasing power of the individual members and increasing
purchasing power with agreement of all participating parties and
financially advantageous to each party. This power does not effect
individual state agencies from participating in any purchasing
alliance or consortium as established in their own program.
If the
director participates in any cooperative purchasing agreement,
alliance, or consortium which is comprised of at least five million
covered lives, the cooperative purchasing agreement, alliance or
consortium may employ an agreed-upon pricing schedule that, in the
judgment of the director and the other participating entities, will
maximize savings to the broadest percentage of the population of
this state: Provided, That any pharmaceutical manufacturer that
deals with such cooperative purchasing agreements, alliances or
consortia may request a waiver from such pricing schedule in West
Virginia or any other participating state for a particular drug
that should be granted if the director finds that the development,
production, distribution costs, other reasonable costs and
reasonable profits excluding marketing, advertising and promotional
costs not essential to bringing the product to market are more than
the schedule price of the pharmaceutical or in those cases in which
the pharmaceutical in question has a sole source. The director
shall determine fees to be paid by the applicant at the time of the
waiver application and proof required to be submitted at the time
of the waiver request to support the validity of the request.
(6) Make recommendations to the Governor and the Legislature
regarding strategies that could more effectively make the health
care delivery system in West Virginia more timely, more patient
centered, provide greater patient access and quality of service and
control health care costs;
(7) Develop and implement other programs, projects and
initiatives to achieve the purposes of this article, including
initiating, evaluating and promoting primary-care medical homes
pursuant to section six of this article and other strategies that
result in greater access to health care, assure greater quality of
care and result in reduced costs for health care delivery services
to the citizens of West Virginia: Provided, That interagency
agreements shall be utilized for services that would be
duplicative:
(8) Work with the Health Care Authority to ensure that the
preventive health care pilots are implementing a primary-care
medical home model as defined in this article;
(9) Develop a five-year strategic plan as set forth in section
six of this article for implementation of West Virginia's health
care system reform initiatives together with recommendations for
administration, policy, legislative rules or legislation. This
plan shall be reported to the Joint Committee on Government and
Finance, the Legislative Oversight Commission on Health and Human
Resources Accountability and the Governor on or before December 31,
2009;
(10) Provide professional development on emerging health care policies and contracting for health care services; and
(11) Evaluate and offer, if resources become available, a
grant program for local communities to encourage healthy lifestyles
in collaboration with the Healthy Lifestyles Coalition.
(b) The director shall employ such professional, clerical,
technical and administrative personnel as may be necessary to carry
out the provisions of this article and with consideration of the
appropriation provided by the Legislature.
(c) The director shall prepare and submit to the Governor and
the Legislature annual proposed appropriations for the next fiscal
year which shall include sums necessary to support the activities
of the Governor's Office of Health Enhancement and Lifestyle
Planning.
(d) The director shall submit an annual report separate from
the strategic plan by January 1 of each year to the Governor and
the Legislative Oversight Commission on Health and Human Resources
Accountability on the condition, operation and functioning of the
Governor's Office of Health Enhancement and Lifestyle Planning.
(e) The director shall supervise the fiscal management and
responsibilities of the Governor's Office of Health Enhancement and
Lifestyle Planning.
(f) The director shall keep an accurate and complete record of
all the Governor's Office of Health Enhancement and Lifestyle
Planning proceedings, records and file all bonds and contracts and
assume responsibility for the custody and preservation of all
papers and records of the office.
(g) The director may convene a series of focus groups, polls
and any other available research tool to determine issues of
importance to all stakeholders after a thorough review of available
research currently in existence. The development of these survey
tools shall be done in conjunction with employers, health care
providers and consumers. Data received from this research should
be easily available to the public and utilized in the development
and design of health benefit programs. The data should also be
accessible to providers to allow them to meet the needs of the
health care market.
(h) The director may propose rules for legislative approval in
accordance with the provisions of article three, chapter twenty-
nine-a of this code to accomplish the goals and purposes of this
article.
§16-29H-5. Creation of the Health Enhancement and Lifestyle
Planning Advisory Council.
(a) The Health Enhancement and Lifestyle Planning Advisory
Council is hereby created. The advisory council is an independent,
self-sustaining council that has the powers and duties specified in
this article.
(b) The advisory council is a part-time council whose members
perform such duties as specified in this article. The ministerial
duties of the advisory council shall be administered and carried
out by the Governor's Office of Health Enhancement and Lifestyle
Planning.
(c) Each member of the advisory council shall devote the time necessary to carry out the duties and obligations of the office.
Those members appointed by the Governor may pursue and engage in
another business or occupation or gainful employment that is not in
conflict with the duties of the advisory council.
(d) The advisory council is self-sustaining and independent,
however it, its members, the director and employees of the
Governor's Office of Health Enhancement and Lifestyle Planning are
subject to article nine-a, chapter six of this code and chapters
six-b, twenty-nine-a and twenty-nine-b of this code.
(e) The advisory council is comprised of the following
governmental officials: The Secretary of the Department of Health
and Human Resources, or his or her designee, the Director of the
Public Employees Insurance Agency, or his or her designee, the
Commissioner of the Office of the Insurance Commissioner, or his or
her designee, the Chair of the West Virginia Health Care Authority,
or his or her designee and the director of the West Virginia
Children's Health Insurance Program or his or her designee. The
council shall also consist of the following public members: One
public member shall represent an organization of senior citizens
with at least ten thousand members within the state, one public
member shall represent the West Virginia Academy of Family
Physicians, one public member shall represent the West Virginia
Chamber of Commerce, one public member shall represent a federally
qualified health center, one public member shall represent the
largest labor organization in the state, one public interest
organization that represents the interests of consumers, one public member shall represent West Virginia Hospital Association, one
public member shall represent the West Virginia Medical
Association, one public member shall represent the West Virginia
Nurse's Association and two ex-officio nonvoting members shall be
the Speaker of the House, or his or her designee, and the President
of the Senate, or his or her designee.
(f) Public members shall be appointed by the Governor with
advice and consent of the Senate. Each public member shall serve
for a term of four years. Of the public members of the advisory
council first appointed, one shall be appointed for a term ending
June 30, 2010, and two each for terms of three and four years. The
remainder shall be appointed for the full four-year terms as
provided in this section. Each public member serves until his or
her successor is appointed and has qualified. The Director of the
Governor's Office of Health Enhancement and Lifestyle Planning
shall serve as chairperson of the advisory council.
(g) Advisory council members may not be compensated in their
capacity as members but shall be reimbursed for reasonable expenses
incurred in the performance of their duties.
(h) The advisory council shall meet within the state at such
times as the chair may decide, but at least once annually. The
advisory council shall also meet upon a call of seven or more
members upon seventy-two hours written notice to each member.
(i) Eight members of the advisory council are a quorum for the
transaction of business.
(j) A majority vote of the members present is required for any final determination by the advisory council. Voting by proxy is
not allowed.
(k) The advisory council shall keep a complete and accurate
record of all its meetings according to section five, article
nine-a, chapter six of this code.
(l) Notwithstanding the provisions of section four, article
six, chapter six of this code, the Governor may remove any advisory
council member for incompetence, misconduct, gross immorality,
misfeasance, malfeasance or nonfeasance in office.
(m) The advisory council has general responsibility to review
and provide advice and comment to the Governor's Office of Health
Enhancement and Lifestyle Planning on its policies and procedures
relating to the delivery of health care services or the purchase of
prescription drugs. The advisory council shall offer advice to the
director on matters over which the office has authority and
oversight. This includes, but is not limited to:
(1) Hiring of professional, clerical, technical and
administrative personnel as may be necessary to carry out the
provisions of this article;
(2) Contracts or agreements;
(3) Rule-making authority; and
(4) Development of policy necessary to meet the duties and
responsibilities of the Governor's Office of Health Enhancement and
Lifestyle Planning pursuant to the provisions of this article.
§16-29H-6. Development of a strategic plan.
The director shall develop a five-year strategic plan for implementation of any and all health care system reform
initiatives. These initiatives shall be included, but are not
limited to:
(1) Development of pilot projects for patient-centered medical
homes as set forth in section nine of this chapter;
(2) Prioritization of chronic conditions to be targeted for
purposes of resource allocation and for greater chronic care
management. This should include pilot projects for community based
health teams for the development of care plans for healthy children
and adults to maintain good health and for at risk populations to
prevent development of preventable chronic diseases;
(3) Development of standardized prior authorization
requirements and processes from insurers;
(4) Coordination with the State Board of Education as set
forth in article two, chapter eighteen of this code to provide for:
(i) The preservation and allocation of recess time away from
instruction and separate from physical education classes in the
state schools;
(ii) Continuing education for school food personnel and a
career hierarchy for food personnel that offers rewards for
continuing education hours and credits;
(iii) School-based physical education coordinators; and
(iv) Placement of a dietician in each regional education
service area throughout the state.
(5) Implementation of school-based initiatives to achieve
greater dietary consistency in West Virginia's school system and to gain greater physical fitness from students;
(6) Development of community-based projects designed for the
construction, development and maintenance of bicycle and pedestrian
trails and sidewalks;
(7) Development and implementation of universal wellness and
health promotion benefits;
(8) Continued promotion and support for efforts to decrease
the number of West Virginians using tobacco products;
(9) Any necessary changes that will increase small businesses
who offer available health insurance as a benefit of employment;
(10) Development of goals to further improve health care
delivery in West Virginia. This should include a means to evaluate
progress toward achieving these goals in a simple and timely
manner;
(11) Measurement of progress of health care providers and
physicians to the adoption and use of electronic medical records in
their offices;
(12 ) Collaboration on health information technology with the
West Virginia Health Information Network, the Bureau for Medical
Services and other appropriate entities which shall include:
(i) Working through the West Virginia Health Information
Network, the Bureau for Medical Services and other appropriate
entities, to develop a collaborative approach for health
information exchange;
(ii) Facilitating and encouraging of ongoing projects such as
electronic medical record resources in community health clinics;
(iii) Encouragement of continued development of hospital
systems and deployment of hospital-supported electronic medical
records when available for hospital-based, hospital-employed and
nonhospital-employed physicians;
(iv) Development of strategies to implement tax incentives,
vendor discounts, enhanced reimbursement and other means to
individual physician offices and clinics to encourage greater
adoption and use of electronic medical records;
(v) Development of recommended electronic medical record best
practices utilizing the Certification Commission for Health Care
Information Technology as the minimum standard;
(vi) Development of funding mechanisms that provide initial
start up funds and a mechanism for sustainability of electronic
medical records; and
(vii) Exploration of federal funding to ensure the most
efficient and cost-effective means of meeting the state's health
information technology objectives.
§16-29H-7. Coordination with higher education.
The director shall consult with all the colleges and
universities in the state, both public and private, with the
state's three medical schools with community and technical colleges
and with the Higher Education Policy Commission. The purpose of
this collaboration would be:
(1) The development of curricula focused on a chronic care
model to reflect the multidisciplinary team approach to the
delivery of health care services in West Virginia as contemplated by the development of a patient centered medical home as that term
is defined in article nine of this chapter; and
(2) The development of technology-centered jobs that would
further the state's efforts in moving toward the broader use of
electronic health records.
§16-29H-8. Continuing efforts to reduce prescription drug prices.
(a) The rule-making authority previously granted to the
Pharmaceutical Cost Management Council in article three-c, chapter
five-a of this code to require the reporting of pharmaceutical
advertising costs is here transferred to the Governor's Office of
Health Enhancement and Lifestyle Planning.
(b) Advertising costs for prescription drugs, based on
aggregate national data, shall be reported to the Governor's Office
of Health Enhancement and Lifestyle Planning by all manufacturers
and labelers of prescription drugs dispensed in this state that
employs, directs or utilizes marketing representatives. The
reporting shall assist this state in its role as a purchaser of
prescription drugs and an administrator of prescription drug
programs, enabling this state to determine the scope of
prescription drug advertising costs and their effect on the cost,
utilization and delivery of health care services and furthering the
role of this state as guardian of the public interest.
(c) The Governor's Office of Health Enhancement and Lifestyle
Planning shall establish by legislative rule pursuant to the
provisions of article three, chapter twenty-nine-a of this code the
reporting requirements of information by labelers and manufacturers which shall include all national aggregate expenses associated with
advertising and direct
promotion of prescription drugs through
radio, television, magazines, newspapers, direct mail and telephone
communications as they pertain to residents of this state.
(d) The following are exempt from disclosure requirements:
(1) All free samples of prescription drugs intended to be
distributed to patients;
(2) All marketing items of a value less than $100;
(3) All payments of reasonable compensation and reimbursement
of expenses in connection with a bona fide clinical trial. As used
in this subdivision, "clinical trial" means an approved clinical
trial conducted in connection with a research study designed to
answer specific questions about vaccines, new therapies or new ways
of using known treatments;
(4) All scholarship or other support for medical students,
residents and fellows to attend significant educational, scientific
or policy making conference of national, regional or specialty
medical or other professional association if the recipient of the
scholarship or other support is selected by the association; and
(5) Any data that identifies specific prescription drugs or
pharmaceuticals by individual name, any group of individuals or
specific individual by name and any specific physician or pharmacy
or group of physicians or pharmacies by name.
(e) The Governor's Office of Health Enhancement and Lifestyle
Planning is authorized to revise existing rules that establish time
lines, the documentation, form and manner of reporting required as he or she, with advice of the advisory council, and determine
necessary changes to effectuate the purpose of this article. The
director shall include in his or her annual report to the
Legislature in an aggregate form, the information provided in the
required reporting.
(f) Notwithstanding any provision of law to the contrary,
information submitted to the director pursuant to this section is
confidential and is not a public record and is not available for
release pursuant to the West Virginia Freedom of Information Act
codified in chapter twenty-nine-b, article one of this code. Data
compiled in aggregate form by the director for the purposes of
reporting required by this section is a public record as defined in
the West Virginia Freedom of Information Act as long as it does not
reveal trade information that is protected by state or federal law
or specific prescription drugs or pharmaceuticals by individual
name, any group of individuals or specific individual by name and
any specific physician or pharmacy or group of physicians or
pharmacies by name.
(g) The director is authorized to consider strategies by which
West Virginia may manage the increasing costs of prescription drugs
and increase access to prescription drugs for all of the state's
residents, including the authority to:
(1) Explore discount prices or rebate programs for senior and
persons without drug coverage;
(2) Explore and if in the best interest of the state and
financially feasible, a counter-detailing program aimed at education health care practitioners about the relative costs and
benefits of various prescription drugs with an emphasis on generic
drugs;
(3) Explore purchasing agreements with public or private
sector entities that could be beneficial in the cost of
pharmaceuticals; and
(4) Explore other strategies, as permitted under state and
federal law, aimed at managing escalating prescription drug cost
and increasing access for citizens of the state and develop
necessary legislation to implement such strategies.
§16-29H-9. Patient-centered medical homes.
(a) Legislative findings. --
The Legislature finds that:
(1) There is a need in the state to transform the health care
services delivery model toward primary prevention and more
proactive care management through the development of
patient-centered medical homes;
(2) The concept of a patient-centered medical home would
promote a partnership between the individual patient, the patient's
various health care providers, the patient's family and, if
necessary, the community. It integrates the patient as an active
participant in their own health and well-being;
(3) The patient-centered medical home provides care through a
multidisciplinary health team consisting of physicians, nurse
practitioners, nurses, physicians assistants, behavioral health
providers, pharmacists, social workers, physical therapists, dental and eye care providers and dieticians to meet the health care needs
of a patient in all aspects of preventative, acute, chronic and
end-of-life care using evidence-based medicine and technology;
(4) In a patient-centered medical home each patient has an
ongoing relationship with a personal physician. The physician
would lead a team of health care providers who take responsibility
for the care of the patient or for arranging care with other
qualified professionals;
(5) Transitioning health care delivery services to a
patient-centered medical home would provide greater quality of
care, increase patient safety and ensure greater access to health
care;
(6) Currently there are medical home pilot projects underway
at the Bureau for Medical Services and the Public Employees
Insurance Agency that should be reviewed and evaluated for
efficiency and a means to expand these to greater segments of the
state's population, most importantly the uninsured.
(b) The patient-centered medical home is a health care setting
that facilitates partnerships between individual patients and their
personal physicians and, when appropriate, the patients' families
and communities. A patient-centered medical home integrates
patients as active participants in their own health and well being.
Patients are cared for by a physician or physician practice that
leads a multidisciplinary health team, which may include, but is
not limited to, nurse practitioners, nurses, physician's
assistants, behavioral health providers, pharmacists, social workers, physical therapists, dental and eye care providers and
dieticians to meet the needs of the patient in all aspects of
preventive, acute, chronic care and end-of-life care using
evidence-based medicine and technology. At the point in time that
the Center for Medicare and Medicaid Services includes the nurse
practitioner as a leader of the multidisciplinary health team, this
state will automatically implement this change.
(c) The Governor's Office of Health Enhancement and Lifestyle
Planning shall consult with the Bureau for Medical Services and the
Public Employees Insurance Agency on current medical home pilot
projects which they are operating for their membership population.
The director shall evaluate these programs in consultation with the
Commissioner of the Bureau for Medical Services and the Director of
the Public Employees Insurance Agency for a means to expand these
beyond the populations currently being served by these pilots.
Once data is available on these pilots that can be reviewed for
planning purposes, the director shall utilize this as a means to
develop and implement additional patient-centered medical home
pilot programs beyond the limited populations served by the Bureau
for Medical Services and the Public Employees Insurance Agency.
The director shall develop four varying types of patient-centered
medical home pilots based upon experience gained from the projects
currently in operation at the Bureau for Medical Services and the
Public Employees Insurance Agency. These patient-centered medical
homes shall be based upon the individual practices of physicians.
(d) The four types of pilot programs shall be:
(1) Chronic Care Model Pilots. -- This model shall focus on
smaller physician practices. Primary care providers shall work
with payers and providers to identify various disease states.
Through the collaborative effort of the primary care provider and
the payers and providers, programs shall be developed to improve
management of agreed upon conditions of the patient. Through this
model, the primary care provider may utilize current practices of
multipayer workgroups. These groups shall be comprised of the
medical directors of the major health care payers and the state
payers along with medical providers and others.
(2) Individual Medical Homes Pilots. -- These pilots shall
focus on larger physician practices. They shall seek certification
from the National Committee on Quality Assurance. That initial
certification will be Level I certification. This would be granted
by virtue of certifying the provider is in the process of
attainting certification and currently have met provisional
standards as set by the National Committee on Quality Assurance.
This provisional certification lasts only one year with no renewal.
(3) Community-Centered Medical Home Pilots. -- This approach
shall link primary care practices with community health teams which
would grow out of the current structure in place for federally
qualified health centers. The community health teams shall include
social and mental health workers, nurse practitioners, care
coordinators and community health workers. These personnel largely
exist in community hospitals, home health agencies and other
settings. These pilots shall identify these resources as a separate team to collaborate with the primary care practices. The
teams would focus on primary prevention such as smoking cessation
programs and wellness interventions as well as working with the
primary care practices to manage patients with multiple chronic
conditions. Within this pilot all health care agencies are
connected and share resources. Citizens can enter the system of
care from any point and receive the most appropriate level of care
or be directed to the most appropriate care. Any financial
incentives in this model would involve all health care payers and
could be used to encourage collaboration between primary care
practices and the community health teams.
(4) Medical Homes for the Uninsured Pilots. -- These pilots
shall focus on medical homes to serve the uninsured. They shall
include various means of providing care to the uninsured with
primary and preventative care. Through this mechanism, a variety
of pilots may be developed that shall include screening, treatment
of chronic disease and other aspects of primary care and prevention
services. The pilots will be chosen based on their design meeting
the requirements of this subsection and the resources available to
provide these services.
(e) The Governor's Office of Health Enhancement and Lifestyle
Planning may promulgate emergency rules pursuant to the provisions
of section fifteen, article three, chapter twenty-nine-a of this
code if they deem them necessary to implement this section.
(1) The Governor's Office of Health Enhancement and Lifestyle
Planning shall establish by guidelines, criteria to evaluate the pilot program and may require participating providers to submit
such data and other information related to the pilot program as may
be required by the Governor's Office of Health Enhancement and
Lifestyle Planning. For purposes of this article, this information
shall be exempt from disclosure under the Freedom of Information
Act in article one, chapter twenty-nine-b of this code.
(2) No later than December 1, 2009, and annually thereafter
during the operation of the pilot program, the Governor's Office of
Health Enhancement and Lifestyle Planning must submit a report to
the Legislative Oversight Commission of Health and Human Resources
Accountability as established in article twenty-nine-e of this
chapter on progress made by the pilot project including suggested
legislation, necessary changes to the pilot program and suggested
expansion of the pilot program.
§16-29H-10. Exemption from Purchasing Division requirements.
The provisions of article three, chapter five-a of this code
do not apply to the agreements and contracts executed under the
provisions of this article, except that the contracts and
agreements shall be approved as to form and conformity with
applicable law by the Attorney General.