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Introduced Version House Bill 2309 History

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hb2309 intr
H. B. 2309


(By Delegates Border, Campbell, Browning and Michael)
[Introduced February 14, 2005; referred to the
Committee on Health and Human Resources then Finance.]




A BILL to amend and reenact §9-2-9 of the code of West Virginia, 1931, as amended, relating to responsibilities of the Secretary of the Department of Health and Human Resources; and requiring that the Secretary consider a method to obtain medicaid reimbursement to retail pharmacies for the cost of certain prescriptions that are prescribed in a dosage that is less than the smallest available package and there is a reasonable expectation that the remaining portion of the broken package cannot be sold.

Be it enacted by the Legislature of West Virginia:
That §9-2-9 of the code of West Virginia, 1931, as amended, be amended and reenacted to read as follows:
ARTICLE 2. DEPARTMENT OF HEALTH AND HUMAN RESOURCES, AND OFFICE OF COMMISSIONER OF HUMAN SERVICES; POWERS, DUTIES AND RESPONSIBILITIES GENERALLY.

§9-2-9. Secretary to develop medicaid monitoring and case management.

(a) On or before the first day of January, one thousand nine hundred ninety-four, the Secretary of the Department of Health and Human Resources shall:
(1) Develop a managed care system to monitor the services provided by the medicaid program to individual clients;
(2) Develop an independent referral service, including the review of individual cases for abuses of the program; and
(3) Develop a schedule for implementation of the managed care and independent referral system. The managed care system shall focus on, but not be limited to, the behavioral health and mental health services.
(b) In addition thereto, and in accordance with applicable federal medicaid laws, the Secretary shall prepare recommendations, to be submitted to the Joint Committee on Government and Finance on or before the first day of January, one thousand nine hundred ninety-four. In developing recommendations the Secretary shall consider as options the following:
(1) Review of medicaid services which are optional under federal medicaid law and identification of services to be retained, reduced or eliminated;
(2) The elimination, reduction or phase-out of: (i) Services which are not generally available to West Virginia citizens not covered under the State's medicaid program; or (ii) services which are not generally covered under group policies of insurance made available to employees of employers within the State;
(3) The elimination or reduction of services, or reduction of provider reimbursement rates, for identified services of marginal utility;
(4) Higher reimbursement rates for primary and preventive care;
(5) Changes in fee structure, which may include a system of prospective payments, and may include establishment of global fees for identified services or diagnoses including maternity care;
(6) Utilization caps for certain health care procedures;
(7) Restriction of coverage for cosmetic procedures;
(8) Identification of excessive use of certain health care procedures by individuals and a policy to restrict excessive use;
(9) Identification of services which reduce the need for more costly options for necessary care and retention or expansion of those programs;
(10) Identification of services for which preauthorization should be requirement for medicaid reimbursement;
(11) Recommendations relating to the development of a demonstration project on long-term care, which demonstration project may be limited to patients with Alzheimer's disease;
(12) A policy concerning the department's procedures for compliance, monitoring and inspection; and
(13) A method of obtaining medicaid reimbursement to retail pharmacies for the actual cost of a full package of any prescription drug when: (A) The prescription is for a nonstock, special order drug; and (B) the prescription is for a dosage that is less than the smallest available package; and (C) there is a reasonable expectation that the remaining portion of the broken package cannot be sold; and
(13) (14) Such other options as may be developed.
(c) The Secretary shall utilize in-state health care facilities for inpatient treatment when such facilities are available. Prior authorization, consistent with applicable federal law, shall be required for out-of-state inpatient treatment.
(d) The Secretary shall report to the Joint Committee on Government and Finance on the development and implementation of medicaid programs that provide incentives to working persons. The Secretary shall consider: Subsidies for low income working persons; individual or small employer buy-ins to the state medicaid fund; prospective payment systems for primary care physicians in underserved areas; and a system to improve monitoring of collections, expenditures, service delivery and utilization.
(e) The Secretary shall report quarterly to the Joint Committee on Government and Finance regarding provider and facility compliance with federal and state medicaid laws, including, but not limited to, the following: The number of inspections conducted during the previous quarter; description of programs, services and facilities reviewed; findings; and recommendations for corrections.

NOTE: The purpose of this bill is to require the Secretary of the Department of Health and Human Resources to consider a method to obtain medicaid reimbursement to retail pharmacies for the cost of certain prescriptions that are prescribed in a dosage that is less than the smallest available package and there is a reasonable expectation that the remaining portion of the broken package cannot be sold.

Strike-throughs indicate language that would be stricken from the present law, and underscoring indicates new language that would be added.
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