H. B. 2885
(By Delegates Perdue, Hatfield, Marshall,
Michael, Moore, Rodighiero and Border)
[Introduced March 2, 2009; referred to the
Committee on Health and Human Resources then Finance.]
A BILL to amend and reenact §16-1A-1, §16-1A-2, §16-1A-3 and §16-
1A-4 of the Code of West Virginia, 1931, as amended; and to
amend said code by adding thereto a new section, designated
§16-1A-5, all relating to establishing a uniform credentialing
form and establishing a single Credentialing Verification
Organization (CVO) or no greater than three regional entities
in the state; authorizing the insurance commission and the
Department of Health and Human Services to put the CVO out for
bid; establishing various aspects of the program; requiring
all health care practitioners and insurers, hospitals, third
party administrators and other health care entities and
continuing the advisory committee for credentialing.
Be it enacted by the Legislature of West Virginia:
That §16-1A-1, §16-1A-2, §16-1A-3 and §16-1A-4 of the Code of
West Virginia, as amended, be amended and reenacted; and that said
code be amended by adding thereto a new section, designated §16-1A-5, all to read as follows:
ARTICLE 1A. UNIFORM CREDENTIALING FOR HEALTH CARE PARTICITIONERS:
§16-1A-1. Legislative findings; purpose.
(a) The Legislature finds:
(1) Credentialing, required by hospitals, insurance companies,
prepaid health plans, third party administrators and other health
care entities, is necessary to assess and verify the education,
training, experience and current clinical competence of health care
practitioners to ensure that qualified professionals treat the
citizens of this state.
(2) Currently, a each of the entities requiring credentialing
has its own credentialing application forms form resulting in
health care practitioners being required to complete multiple forms
listing the same or similar information. The duplication is
costly, time consuming and not in the best interests of the
citizens of this state has been created to reduce duplication and
increase efficiency. Each health care entity performs primary
source verification for the practitioners who apply to that entity
for affiliation. This duplication of primary source verification
is time consuming and costly.
(3) The Secretary of the Department of Health and Human
Resources and the Insurance Commissioner share regulatory authority
over the entities requiring credentialing.
(b) The purpose of this article is to authorize the development of uniform credentialing application forms by those
public officials regulating the entities that require credentialing
and to establish an advisory committee to assist in developing a
uniform credentialing process and
implementing to implement the
use of uniform credentialing
through a credentialing verification
organization of one or no greater than three entities in this
state.
§16-1A-2. Development of uniform credentialing application forms
Definitions.
Notwithstanding any provision of this code to the contrary,
the secretary of the department of health and human resources and
the insurance commissioner shall jointly propose rules for
legislative approval in accordance with the provisions of article
three, chapter twenty-nine-a of this code governing the development
and use of uniform application forms for credentialing,
recredentialing or updating information of health care
practitioners required to use the forms.
(a) "Commission" is the insurance commission.
(b) "CVO" is a Credentialing Verification Organization which
verifies the professional qualifications of all practitioners that
are participating providers and that provide health care services
to consumers.
(c) "The department" is the Department of Health and Human
Resources;
(d) "Health care practitioners" means acupuncturists,
audiologists, chiropractors, dental assistants, dental hygienists,
dentists, dieticians, emergency medical technicians including but
not limited to, basic, cardiac/critical, intermediate and
paramedic, homeopaths, licensed practical nurses, licensed
vocational nurses, licensed professional counselors including
alcohol, substance abuse and family/marriage counselors, mental
health counselors, massage therapists, naturopaths, nuclear
medicine technologists, nurse anesthetists, nurse midwives, nurse
practitioners, nutritionists, occupational therapists,
optometrists, orthotic/prosthetic fitters, pharmacists and nuclear
pharmacists, physical and rehabilitation therapists, physician
assistants, allopathic and osteopathic physicians, residents and
interns, allopathic and osteopathic podiatrists, psychologists,
clinical, radiation therapy technologists, radiologic
technologists, registered nurses, respiratory therapists,
respiratory therapy technicians, clinical social workers and speech
and language pathologists.
(e) "Joint Commission" is an independent not-for-profit
organization that evaluates and accredits more than 15,000 health
care organizations and programs in the United States.
(f) NCQA means the National Committee for Quality Assurance,
which is a private, 501(c)(3) not-for-profit organization
dedicated to improving health care quality.
(g) "Primary source verification procedure" means the
procedure used by a credentialing organization to verify the
accuracy of documents and credentialing information submitted to it
by a health care practitioner who is applying for affiliation with
a health care entity.
(h) "URAC" means the American Accreditation Healthcare
Commission.
§16-1A-3. Credentialing Verification Organization.
(a) The secretary of the department of health and human
resources and the insurance commissioner shall jointly establish an
advisory committee to assist them in the development and
implementation of the uniform credentialing process in this state.
The advisory committee shall consist of eleven appointed members.
Six members shall be appointed by the secretary of the department
of health and human resources: One member shall represent a
hospital with one hundred beds or less; one member shall represent
a hospital with more than one hundred beds; one member shall
represent another type of health care facility requiring
credentialing; one member shall be a person currently credentialing
on behalf of health care practitioners; and two of the members
shall represent the health care practitioners subject to
credentialing. Five members shall be representative of the
entities regulated by the insurance commissioner that require
credentialing and shall be appointed by the insurance commissioner: One member shall represent an indemnity health care insurer; one
member shall represent a preferred provider organization; one
member shall represent a third party administrator; one member
shall represent a health maintenance organization accredited by
American accreditation health care commission; and one member shall
represent a health maintenance organization accredited by the
national committee on quality assurance. The secretary of the
department of health and human resources and the insurance
commissioner, or the designee of either or both, shall be nonvoting
ex officio members.
(b) Of the members of the advisory committee first appointed,
four shall be appointed for a term of one year, four shall be
appointed for a term of two years, and three shall be appointed for
a term of three years. At the expiration of the initial terms,
successors will be appointed to terms of three years. Members may
serve an unlimited number of terms. When a vacancy occurs as a
result of the expiration of a term or otherwise, a successor of
like qualifications shall be appointed.
(c) The advisory committee shall meet at least annually to
review the status of uniform credentialing in this state, and may
make further recommendations to the secretary of the department of
health and human resources and the insurance commissioner as are
necessary to carry out the purposes of this article. Any uniform
forms and the list of health care practitioners required to use the uniform forms as set forth in legislative rule proposed pursuant to
section two of this article may be amended as needed by procedural
rule.
(a) The department and the commission are hereby given
exclusive authorization to execute such contracts as are necessary
to carry out the provisions of this article to provide a single
CVO or no greater than three regional CVO's in the state that will
provide electronic access to the West Virginia uniform
credentialing application to all practitioners. The initial
contract shall be for a period of five years at which time other
credentialing organizations may enter the state. The selected
entity or entities shall be the central repositories for
information required by hospitals, and payers as part of the
credentialing process, will verify all information provided by the
practitioner, including site visits to the practitioner's office if
required by a health plan and will make this information available
electronically to hospitals, providers and all payers. The entity
or entities will also establish procedures for ensuring that
practitioners' files are kept up to date by issuing quarterly
reminders for updated information.
The CVO's shall be given preference if organized within the
state of West Virginia. The CVO's are required to include on their
board representatives of those classes of entities who will be
using the CVO. The CVO shall develop a payment system that will cover the costs of the program and that is evaluated by the
advisory committee created in section four of this article prior to
implementation.
(b) Health care practitioners as well as hospitals, insurance
companies, prepaid health plans, third party administrators and
other health care entities shall utilize the services of a single
CVO or no greater than three regional CVO's awarded contracts by
the department and the commission upon the effectiveness of the CVO
or CVO's. This mandate shall not be effective until and is
premised upon:
(1) Each CVO being certified by the National Committee for
Quality Assurance (NCQA);
(2) Accreditation by URAC and
(3) Demonstrated compliance with the principles for
credentials verification organizations set forth by the joint
commission.
(c) Each healthcare practitioner required to use the CVO is
required to use the uniform credentialing application form
developed by the advisory committee.
(d) Each healthcare practitioner required to use the
credentialing verification organization shall be recredentialed
every two years on their birthday. Those born in odd years shall
be recredentialed in odd years and those born in even years shall
be recredentialed in even years. If a large employer so decides, the CVO may establish a single credentialing date for all
practitioners within the employer organization.
(e) The CVO shall communicate by letter, fax or e-mail a
notice of receipt and a notice of any additional documents or
information needed to complete the application within twenty-one
days of receipt of the application.
(f) Each applicant shall be credentialed within sixty days or
no greater than ninety days of the application being deemed
complete. The application is deemed complete when all information
has been provided by the practitioner and all items have been
verified.
(g) If the insurance company takes more than the ninety days
to credential a health care practitioner, the insurer must issue
a provisional approval. This practice accrues whether or not the
practitioner's credentials are accepted by the insurer.
(h) In the additional process of granting privileges, the
hospital shall follow their own governing documents for granting
privileges.
§16-1A-4. Advisory committee.
(a) The Secretary of the Department of Health and Human
Resources and the Insurance Commissioner shall jointly establish an
advisory committee to assist them in the development and
implementation of the uniform credentialing process in this state.
The advisory committee shall consist of eleven appointed members. Six members shall be appointed by the Secretary of the Department
of Health and Human Resources: One member shall represent a
hospital with one hundred beds or less; one member shall represent
a hospital with more than one hundred beds; one member shall
represent another type of health care facility requiring
credentialing; one member shall be a person currently credentialing
on behalf of health care practitioners; and two of the members
shall represent the health care practitioners subject to
credentialing. Five members shall be representative of the
entities regulated by the insurance commissioner that require
credentialing and shall be appointed by the insurance commissioner:
One member shall represent an indemnity health care insurer; one
member shall represent a preferred provider organization; one
member shall represent a third party administrator; one member
shall represent a health maintenance organization accredited by
American accreditation health care commission; and one member shall
represent a health maintenance organization accredited by the
national committee on quality assurance. The Secretary of the
Department of Health and Human Resources and the Insurance
Commissioner, or the designee of either or both, shall be nonvoting
ex officio members.
(b) Of the members of the advisory committee first appionted,
four shall be appointed for a term of one year, four shall be
appointed for a term of two years, and three shall be appointed for a term of three years. At the expiration of the initial terms,
successors will be appointed to terms of three years. Members may
serve an unlimited number of terms. When a vacancy occurs as a
result of the expiration of a term or otherwise, a successor of
like qualifications shall be appointed.
(c) The advisory committee shall meet at least annually to
review the status of uniform credentialing in this state, and may
make further recommendations to the Secretary of the Department of
Health and Human Resources and the Insurance Commissioner as are
necessary to carry out the purposes of this article. Any uniform
forms and the list of health care practitioners required to use the
uniform forms as sete forth in legislative rule proposed pursuant
to section two of this article may be amended as needed by
procedural rule.
(b) The Secretary of the Department of Health and Human
Resources and the Insurance Commissioner shall collaborate with the
CVO and the advisory committee established above, to develop a
uniform credentialing form for use by all health care practitioners
required to use the CVO. In addition, the CAQH and the state
uniform credentialing form shall be acceptable.
§16-1A-5. Report required.
On or before the first day of January 1,
two thousand two
2010, the
secretary of the department of health and human resources
and the insurance commissioner department and the commission shall jointly report to the Legislative Oversight Commission on Health
and Human Resources Accountability on the need, if any, for further
legislation to implement the use of the uniform credentialing
application
forms form developed pursuant to the legislative rule
authorized by section two of this article.
NOTE: The purpose of the bill is to create a single
Credentialing Verification Organization or no more than three such
entities in the state and to establish parameters for the
credentialing process.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.
This bill shall also move current §16-1A-3 to §16-1A-4, with
additional changes in the body of said section.
This bill shall also move current §16-1A-4 to §16-1A-5, with
additional changes in the body of said section.
THIS IS AN INTERIM BILL RECOMMENDED FOR PASSAGE BY THE SELECT
COMMITTEE D - HEALTH.