H. B. 2216
(By Delegate Susman)
[Introduced February 11, 2005; referred to the
Committee on Health and Human Resources then the
Be it enacted by the Legislature of West Virginia:
A BILL to amend the code of West Virginia, 1931, as amended, by
adding thereto a new article, designated §9-4E-1 and §9-4E-2,
all relating to exempting certain physicians from obtaining
preauthorization before dispensing psychotrophic medications
to mentally ill medicaid recipient patients in order to avoid
catastrophic results from inadequate and untimely treatment;
and providing findings by the Legislature.
That the code of West Virginia, 1931, as amended, be amended
by adding thereto a new article, designated §9-4E-1 and §9-4E-2,
all to read as follows:
ARTICLE 4E. MEDICAID PREAUTHORIZATION EXEMPTION FOR CERTAIN
PHYSICIANS TREATING MENTALLY ILL.
The Legislature hereby makes the following findings:
(a) Mentally ill patients who are recipients of medicaid have
the least means to obtain proper medications to control their
(b) These medicaid recipients, if not promptly treated and
then, maintained on medications which work, will, by their
uncontrolled mental illnesses suffer greatly, often inflicting
significant harm to themselves and other persons, and consequently,
increase costs to society as a whole.
(c) The current belief of the scientific medical community is
that major mood disorders, such as bipolar disorder, schizophrenia
and other psychotic disorders, if not promptly treated, may cause
organic brain damage which leads to limited true recovery when the
disorders are treated, thus decreasing the prospect of mentally ill
persons being able to return to optimum health, to work or to
(d) It is ethically imperative that the specialists in the
medical neurosciences have unfettered ability to promptly medically
intervene in treating new acute mentally ill patients and to
continue proven medications for those patients.
(e) The procedure of the West Virginia Medicaid Pharmacy of
requiring preauthorization before dispensing medications to
mentally ill medicaid recipients is unduly arduous and difficult
and most of all, too time consuming for practitioners with large
numbers of mentally ill patients who require immediate treatment to avoid permanent injury or other undesirable consequences.
(f) The imposition of a "first fail" plan before a physician
can adjust or change a medication not on the approved list of
psychotrophic medications is medically and psychiatrically unsound
and the seriously mentally ill patient's condition will usually not
remain stable for long without prompt treatment. If these persons
are not sooner and more promptly treated, a significant probability
exists that a sharp increase in hospitalizations will result,
thereby increasing medical costs to the State.
§9-4E-2. Preauthorization exemption for certain physicians.
Physician specialists in neurosurgery, neurology or psychiatry
with appropriate residency training to have been Board eligible at
the time of completing their residency training and to sit for
their specialty examinations, as well as neurosurgeons,
neurologists and psychiatrists in post-graduate training programs,
may prescribe to medicaid recipients suffering serious mental
illness, psychotrophic medications, without the requirement of any
preauthorization procedure otherwise required. For the purposes of
this article, "psychotrophic medications" mean FDA approved
antipsychotics, neuroleptics (typical and atypical),
antidepressants, mood stabilizers, antianxiety agents, hypnotics,
stimulants, antiParkinson agents and antiAlzheimer agents.
NOTE: The purpose of this bill is to exempt certain
physicians from obtaining preauthorization before being able to
dispense psychotrophic medications to mentally ill medicaid
This article is new; therefore, strike-throughs and
underscoring have been omitted.