H. B. 2866
(By Delegates Perdue, Hatfield, Boggs,
Stalnaker, Campbell, Fleischauer,
Armstead and Border)
[Introduced January 9, 2008; referred to the
Committee on the Judiciary.]
A BILL to amend and reenact §9-2-9 and §9-4-3 of the Code of West
Virginia, 1931, as amended, all relating to requiring public
notice of state plan amendments prior to submission for
federal approval and increasing the membership of the Medicaid
Advisory Board.
Be it enacted by the Legislature of West Virginia:
That §9-2-9 and §9-4-3 of the Code of West Virginia, 1931, as
amended, be amended and reenacted, all to read as follows:
ARTICLE 2. COMMISSIONER OF HUMAN SERVICES; POWERS, DUTIES AND
RESPONSIBILITIES GENERALLY.
§9-2-9. Secretary to develop Medicaid monitoring and case
management.
(a) 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.
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 is
a 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) 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.
(f) The secretary shall, upon federal certification of the
claims management system, ensure that the claims management system
processing Medicaid claims provides:
(1) Detailed quarterly financial reports to the Legislative
Oversight Commission on Health and Human Resources Accountability;
(2) A management reporting system no later than the first day
of July, two thousand six; and
(3) Specific utilization data by provider, member eligibility
groups and service no later than the first day of October, two
thousand six.
(g) The secretary shall provide public notice of any proposed
amendment to the state plan for Medicaid or proposed changes to the reimbursement schedule for Medicaid. The notice shall be filed
with the Secretary of State, for publication in the State Register,
including the text of the proposed amendment and a fiscal note.
The notice shall fix a date, time and place for the receipt of
public comment in the form of written statements and any relevant
documents. The proposed amendment may not be filed for federal
approval until thirty days following the close of the public
comment period.
ARTICLE 4. STATE ADVISORY BOARD; MEDICAL SERVICES FUND; ADVISORY
COUNCIL; GENERAL RELIEF FUND.
§9-4-3. Advisory council.
The advisory council, created by chapter one hundred
forty-three, Acts of the Legislature, regular session, one thousand
nine hundred fifty-three, as an advisory body to the State Medicaid
Agency with respect to the medical services fund and disbursements
therefrom and to advise about health and medical services, is
continued so long as the medical services fund remains in
existence, and thereafter so long as the State Medicaid Agency
considers the advisory council to be necessary or desirable, and it
is organized as provided by this section and applicable federal law
and has those advisory powers and duties as are granted and imposed
by this section and elsewhere by law:
Provided, That the
continuation of the advisory council is subject to a preliminary
performance review pursuant to the provisions of article ten, chapter four of this code, evaluating the effectiveness and
efficiency of the advisory council, to be conducted during the
interim of the Legislature in the year two thousand six by the
Joint Committee on Government Operations.
The term of office of those members serving on the advisory
council, on the effective date of the amendments made to this
section by the Legislature during its regular session in the year
one thousand nine hundred ninety-eight, shall continue until they
are reappointed or replaced in accordance with the provisions of
this section.
The advisory council shall consist of not less than nine
members, nor more than
thirteen fifteen members, all but
two four
of whom shall be appointed by the State Medicaid Agency and serve
until replaced or reappointed on a rotating basis. The heads of
the Public Health and Public Welfare Agencies are members ex
officio.
The cochairs of the Legislative Oversight Commission on
Health and Human Resources Accountability, or their designees, are
nonvoting ex officio members. The remaining members comprising the
council consist of a person of recognized ability in the field of
medicine and surgery with respect to whose appointment the State
Medical Association shall be afforded the opportunity of making
nomination of three qualified persons, one member shall be a person
of recognized ability in the field of dentistry with respect to
whose appointment the State Dental Association shall be afforded the opportunity of nominating three qualified persons, and the
remaining members shall be chosen from persons of recognized
ability in the fields of hospital administration, nursing and
allied professions and from consumers groups, including Medicaid
recipients, members of the West Virginia Directors of Senior and
Community Services, Labor Unions, Cooperatives and
Consumer-sponsored Prepaid Group Practices Plans.
The council shall meet on call of the State Medicaid Agency.
Each member of the advisory council shall receive reimbursement for
reasonable and necessary travel expenses for each day actually
served in attendance at meetings of the council in accordance with
the state's travel regulations. Requisitions for the expenses
shall be accompanied by an itemized statement, which shall be filed
with the Auditor and preserved as a public record.
The advisory council shall assist the State Medicaid Agency in
the establishment of rules, standards and bylaws necessary to carry
out the provisions of this section and shall serve as consultants
to the State Medicaid Agency in carrying out the provisions of this
section.
NOTE: The purpose of this bill is to
require public notice of
state plan amendments prior to submission for federal approval and
increasing the membership of the Medicaid Advisory Board.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.