HB4054 INTR

H. B. 4054
(By Mr. Speaker, Mr. Chambers, and Delegate Burk
By Request of the Executive)

(Introduced January 19, 1994; referred to the Select Committee on Health Care Policies).

A BILL to repeal section ten-b, article one, chapter sixteen of the code of West Virginia, one thousand nine hundred thirty-one, as amended; to repeal article one-a of said chapter; to repeal articles five, eight, nine and eleven of chapter twenty-six of said code; to repeal section one, article two, chapter twenty-seven of said code; to amend and reenact section one, article three, chapter eighteen-c of said code; to further amend said article three by adding thereto two new sections, designated sections three and four; to amend and reenact section fifteen, article one, chapter thirty of said code; to further amend said article one by adding thereto a new section, designated section seventeen; and to further amend said code by adding thereto a new chapter, designated chapter sixteen-a, all relating to state health care system and the restructuring thereof, including, but not limited to, the creation of a state health care authority; legislative findings; legislative intent; definitions; creating West Virginia health care authority; setting forth powers of health care authority; providing for executive committee of directors of health care authority; specifying various actions relating to health and health care for which health care authority shall be responsible; requiring health care authority to update state health plan; requiring certain actions by state health programs and departments managing state health facilities; establishing an executive secretary of health care licensing boards and task force for implementing improvements and staff consolidation in licensing board system; requiring health care authority to develop plan for long-term care in state and to develop health-promotion programs; creating public health system advisory council; focusing public health on core functions and population-based services; requiring health care authority to develop system for certifying health care networks and exempting from coverage of federal and state antitrust laws; requiring health care authority to develop an information system to provide basis for reform; establishing rural health loan program and rural health scholars program; continuing office of executive secretary of health professional licensing boards; and protecting from liability any member of certain professional groups who reports or otherwise provides evidence to the governing board of such reporting persons's profession, of the negligence, impairment or incompetence of another member of such profession, except in cases involving actual malice.

Be it enacted by the Legislature of West Virginia:

That section ten-b, article one, chapter sixteen of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be repealed; that article one-a of said chapter be repealed; that articles five, eight, nine and eleven of chapter twenty-six of said code be repealed; that section one, article two, chapter twenty-seven of said code be repealed; that section one, article three, chapter eighteen-c of said code be amended and reenacted, that said article three be further amended by adding thereto two new sections, designated sections three and four; that section fifteen, article one, chapter thirty of said code be amended and reenacted; and that said article one be further amended by adding thereto a new section, designated section seventeen, and that said code be further amended by adding thereto a new chapter, designated chapter sixteen-a, all to read as follows:

CHAPTER 16A. WEST VIRGINIA HEALTH CARE ACCESS

AND REFORM ACT OF 1994.

ARTICLE 1. GENERAL PROVISIONS.

§ 16A-1-1. Short title.

This chapter shall be known and may be cited as the "West Virginia Health Care Access and Reform Act of 1994."

§ 16A-1-2. Legislative findings.

The Legislature hereby finds and declares that:

(a) West Virginia citizens face extreme financial and medical risk because the state's and nation's existing health care system does not provide adequate and appropriate access to affordable health care services.
(b) West Virginia's business and taxpayers are burdened with skyrocketing health care costs that drain public revenues and place our private sector at a competitive disadvantage.
(c) Too many West Virginia communities do not have a sufficient number of health professionals to provide the primary and preventive care services needed by their communities. Forty-three West Virginia counties have been designated as having primary care health professional shortage areas.
(d) West Virginia's citizens suffer from some of the worst health conditions in the country, with extremely high rates of heart disease, cancer, diabetes, hypertension, smoking and obesity.
(e) Change in West Virginia's health care system is inevitable, being demanded by the public, by anticipated federal legislation and by marketplace forces.
(f) The absence of a single point of accountability, expertise and authority to manage West Virginia's health care system undermines efforts to implement comprehensive and cost effective health care reform strategies to provide quality, affordable health care services for all West Virginians.

§ 16A-1-3. Legislative intent.

It is the intent of the Legislature that all actions taken pursuant to this act serve the following core set of health care reform principles, subject to available funds:

(a) That all persons in the state have access to quality health care services without reliance on uncompensated care or unreimbursed services;
(b) That the state have strong regulatory and market mechanisms to control rising health care costs for all payors on an equitable basis;
(c) That systems of primary and preventive care services exist for all persons on the community level, integrated with regional and statewide sources of secondary and tertiary care;
(d) That health care consumers be able to choose between different sources, methods, and providers of health care services;
(e) That incentives and other mechanisms encourage West Virginians to practice healthy lifestyles and to address the state's relatively poor health status;
(f) That health care providers be reimbursed with an equitable, competitive and timely system that minimizes administrative costs and eliminates the need for health care providers to differentiate among consumers based on their source of payment;
(g) That health care providers be able to choose their practice setting while being given options and incentives to participate in cost effective systems of health care services.

§ 16A-1-4. Definitions.

For purposes of this chapter:

(a) "Authority" means the West Virginia health care authority established by section one, article two of this chapter.
(b) "Capitated health system" means a health services system which provides its enrollees with a package of health services, directly in its own clinical setting, or through contractual arrangements, for a predetermined, prepaid fee which does not change with the nature or extent of services provided.
(c) "Health care network" means a locally based organization of health care, education and support service providers, which promotes a cooperative and collaborative approach to the delivery of health care services and provides for the complete range of health care and, in some cases, social needs of its patients, and which is planned, established and operated on a community level within the framework of a state plan.
(d) "Certificate of need" means certificate of need as described in article two-d, chapter sixteen of this code.
(e) "Certificate of need allocation" means the maximum aggregate principal amount of certificates of need allocated by the authority to a particular class of institutional health services, as defined in article two-d, chapter sixteen of this code, in a particular area during a calendar year, all in accordance with section five, article four of this chapter.
(f) "Cost containment" means measures designed to control and reduce increases in health care expenditures.
(g) "Expenditure target" means a budget developed for aggregate health care spending within a specified time period.
(h) "Global budget" means an annually set or negotiated cap on total health care expenditures. A global budget may apply to a region, a population, a group of providers, a particular hospital or a health plan responsible for the comprehensive care of its members.
(i) "Health" means both physical and mental health.
(j) "Health care facility" means any facility, including, but not limited to, hospitals, ambulatory surgical facilities, nursing homes, mental health centers and primary care clinics designated as such by rule of the authority: Provided, That such designation may be different for different purposes provided by this chapter.
(k) "Health care provider" means any person, facility or institution, including, but not limited to, a person, facility or institution licensed, certified or authorized by law to provide health care services in this state, designated as such by rule of the authority: Provided, That such designation may be different for different purposes provided by this chapter.
(l) "Health care services" means any services delivered to a person to promote healthful living, maintain health or stability of chronic conditions, treat illness, injury or disease or restore function, including, but not limited to, health promotion and education, primary care, secondary care and tertiary care.
(m) "Health education" means any combination of learning opportunities designed to facilitate voluntary adaptations of behavior conducive to health.
(n) "Health maintenance organization" means an organization which provides its enrollees with a package of health services, directly in its own clinical setting, or through contractual arrangements, for a predetermined, prepaid fee which does not change with the nature or extent of services provided, and which organization complies with applicable provisions of this code, including, but not limited to, article twenty-five-a, chapter thirty-three of this code.
(o) "Health promotion" means any combination of health education and related organizational, political and economic interventions designed to facilitate behavioral and environmental adaptations that will improve or protect health.
(p) "Health services" means services, including drugs and durable medical equipment, delivered to individuals and families by a wide range of health professionals that may be preventive, diagnostic, curative, restorative or palliative. Health services may also be directed to the entire population or communities. This latter category of services includes prevention and control of communicable diseases, community health protection, and a wide range of health promotion and education activities in communities, schools and workplaces.
(q) "Long-term care" means the health care, personal care and social services required by persons who have lost, or never acquired, some degree of functional capacity, delivered on a long-term basis.
(r) "Managed care" means a system of comprehensive and coordinated health care, which includes care management, quality assurance, utilization review and similar measures to ensure appropriate, high quality health care and the appropriate use of limited resources and containment of costs.
(s) "Medicaid" means the state and federal program that provides reimbursement for health care services for eligible persons and families.
(t) "Medicare" means the federal program administered by the United States social security administration that covers the medical care of patients over age sixty-five and certain qualified persons under age sixty-five.
(u) "Payor" means public, private, governmental and nongovernmental payors or purchasers of health care services, all in conformance with federal laws, rules and regulations.
(v) "Practice guideline" means a systematically developed statement designed to assist health care providers and patients to make decisions about appropriate health care for specific clinical conditions.
(w) "Preventive care" means actions and programs undertaken to prevent disease or its consequences, including, without limitation, health care programs such as immunizations aimed at warding off illnesses; early detection of diseases, such as pap smears; to inhibit further deterioration of the body, such as exercise or prophylactic surgery; to promote health through altering behavior, such as health education programs; and to improve the healthfulness of the environment.
(x) "Primary care" means health care delivery that emphasizes first contact care and assumes overall and ongoing responsibility for a person in health promotion, disease prevention, health maintenance, diagnosis and treatment of illness and injury more simple or common than would be treated with secondary or tertiary care, restorative care and management of chronic care. Primary care involves a relationship between a patient and primary care provider or a primary care provider team, which seeks to achieve comprehensive coordination of the patient's health care, including the educational, behavioral, biological and social aspects thereof. It is a patient-oriented approach that emphasizes the continuity of comprehensive care over the full spectrum of health services, beginning with patient assessment, wellness and prevention and extending through health management, lifestyle modification, health education and care management of needed services. The primary care provider is the patient's advocate within the health care delivery system. The appropriate use of consultants, specialists and community and other resources is an integral function of effective primary care.
(y) "Public health" means that broad segment of health the mission of which is to fulfill society's interest in assuring conditions in which people can be healthy; involves organized community efforts to prevent disease and to promote health, based on epidemiology; and encompasses both activities undertaken within the formal structure of government and the associated efforts of private and voluntary organizations and individuals. The principal functions of public health are assessment, policy development and assurance of a healthful natural environment rather than the provision of individualized health services.
(z) "Quality assurance" means a program to measure and monitor the quality of care rendered by a group or institution and includes procedures to remedy deficiencies or problems.(aa) "State agency" means any division, agency, board, department, authority, bureau, commission or any other state governmental body.
(bb) "State health facility" means any state-operated treatment facility named in article two, chapter twenty-seven of this code, any acute or extended care facility named in chapter twenty-six of this code, and other state-owned health facility hereafter created, relating to the provision of health care services of any type.
(cc) "State health plan" means the plan, as modified or replaced by the authority, establishing the guidelines, goals and objectives, and other mechanisms by and through which state health programs serve the provisions of this chapter.
(dd) "State health programs" means those state agencies determined by the health care authority to have policies, programs, services, duties or responsibilities relating to health or health care. At a minimum, such programs shall include the department of health and human resources, the health care cost review authority, the division of workers compensation, the public employees' insurance agency, the division of insurance, and the division of rehabilitation services.

§ 16A-1-5. West Virginia health care authority created; composition; appointment of members; terms of office; conflict of interest provisions; expenses and compensation; meetings; quorum; records.

(a) There is hereby created the West Virginia health care authority as a governmental instrumentality and a body corporate with the powers and duties set forth in this chapter.

(b) The authority shall consist of five members appointed by the governor with the advice and consent of the Senate. The chair shall be designated by the governor. There shall be one member from each congressional district existing on the effective date of passage of this act and two at large members who are not members of the same congressional district. No more than three of the members shall be from the same political party. The terms of each member shall be for six years, except that the governor shall designate one of the initial members to serve an initial term ending the first day of July, one thousand nine hundred ninety-six, and two of the initial members to serve an initial term ending the first day of July, one thousand nine hundred ninety-eight. The governor may remove a member of the authority only for cause as provided in article six, chapter six of this code. Any member appointed to fill a vacancy occurring prior to the expiration of a term shall be appointed only for the remainder of the unexpired term. The governor shall make the initial appointments to the board no later than the first day of June, one thousand nine hundred ninety-four. Before entering upon his or her duties as a member of the authority, each member shall comply with the requirements of article one, chapter six of this code.
(c) An individual may not serve as a member of the authority, if the individual, or the individual's spouse, is one of the following:
(1) A health care provider;
(2) An individual who is an employee or member of the board of directors of, has a five percent or greater ownership interest in, or derives more than one thousand dollars per year substantial income from, a health care provider, health plan, pharmaceutical company, or a supplier of medical equipment, devices or services;
(3) A person who derives more than one thousand dollars per year from the provision of health care;
(4) (i) A member or employee of an association, law firm, or other institution or organization that represents the interests of one or more health care providers, health plan or others involved in the health care field, or (ii) an individual who practices as a professional in an area involving health care.
(d) Members of the authority shall be paid a per diem of two hundred dollars and actual expenses for days, or proportionately for half days, traveling to, from or engaged in authority business.
(e) A majority of the members of the authority shall constitute a quorum, and a quorum must be present for the authority to conduct business. The affirmative vote of at least the majority of the members present is necessary for any action taken by vote of the authority. No vacancy in the membership of the authority impairs the rights of a quorum by vote to exercise all the rights and perform all the duties of the authority. Notwithstanding any other provision in this code to the contrary, the authority, or any members thereof, may meet with the staff of the authority for the purposes of receiving and analyzing data, reports, and other information and discussing matter for which the authority is responsible, and all such meetings are exempt from the requirements of section three, article nine-a, chapter six of this code: Provided, That no decisions requiring a vote of the authority may be made at such a meeting and all other meetings of the authority shall be conducted in accordance with the provisions of said article.
§ 16A-1-6. Executive committee.
(a) The authority shall appoint a three-person full-time executive committee, consisting of a director of administration, a director of research and development, and a director of consumer affairs, to manage the operations of the authority:
(1) The director of administration shall be the chief operations officer of the authority and shall be responsible for coordinating the ongoing efforts of state health programs to achieve the health care reform principles defined in section three of this article and as provided for in the state health plan. The director of administration shall also be responsible for gathering and evaluating provider concerns about the health care system in the state and for developing strategies to respond to those concerns.
(2) The director of research and development shall be responsible for overseeing all data collection and information system reforms, drafting amendments to the state health plan and proposed health care reform legislation, and other health care reform planning and evaluation functions.
(3) The director of consumer rights shall be responsible for evaluating consumer concerns about the quality and accessibility of health care services in the state and developing strategies to respond to those concerns.
(b) Each director shall report directly to the authority and may be removed only from his or her position only by majority vote of the authority.
§ 16A-1-7. Powers of the authority generally.
(a) The authority has the following general administrative powers:
(1) To acquire, own, hold and dispose of property, whether real, personal, tangible, intangible or mixed.
(2) To enter into leases and lease-purchase agreements, whether as the lessee or lessor.
(3) To make bylaws and to develop and implement procedures governing the internal operation and administration of the authority, including guidelines for purchasing and performing its duties under this chapter involving the expenditure of funds.
(4) To adopt an official seal.
(5) To employ staff, which shall be exempt from the provisions of article six, chapter twenty-nine of this code.
(6) To make contracts of every kind and nature, including, but not limited to, interstate agreements or compacts, and to execute all instruments necessary or convenient for performing its duties hereunder.
(7) To solicit, accept and use gifts, bequests or donations of property funds, security interests, money, materials, labor, supplies or services from any governmental entity or unit or any person, firm, foundation or corporation.
(8) To require, notwithstanding any other provision in this code to the contrary, all officers and employees of any state agency, board, commission, or authority to furnish any records or information which the authority or its staff requests for carrying out the purposes of this chapter: Provided, That the authority shall hold any records or information received as confidential as the originating agency, board, commission or authority would be required to hold confidential by state or federal law.
(9) To charge fees for services rendered by, applications made to, certificates granted or information distributed by, the authority for public and private entities and individuals, and to require reimbursement for expenses incurred by the authority for public and private entities and individuals in rendering services, receiving applications, granting certificates and providing information to, all as determined by rule of the authority. Payments of fee shall be deposited into a special revolving fund in the state treasury. Any balance, including accrued interest, in the special revolving fund at the end of any fiscal year shall not revert to the general revenue fund, but shall remain in the special revolving fund for use by the authority in performing its duties under this chapter in ensuing fiscal years.
(10) To form or participate in the formation of public, quasi-public or public-private corporations, foundations or other entities.
(11) To promulgate pursuant to the provisions of chapter twenty-nine-a of this code such rules as it deems necessary to implement the provisions of this chapter and prevent the circumvention and evasion thereof, including rules for all policies, programs, and services relating to health or health care services operated, financed, monitored, managed, controlled, regulated or provided by any state health program.
(12) To obligate and expend funds prior to the service provided therefor, so as to enable the authority to provide start-up funds for various programs and projects.
(13) To conduct such hearings and investigations as it deems necessary for the performance of its duties. The authority shall announce the time, date and purpose of all hearings in a timely manner and such hearings shall be open to the public except as may be necessary to conduct business of an executive nature. Any hearing may be conducted by the authority or a hearing examiner appointed for such purpose. The chair of the authority may issue subpoenas and subpoenas duces tecum, which shall be issued and served pursuant to the time and enforcement specifications in section one, article five, chapter twenty-nine-a of this code.
(14) To exercise any and all other powers necessary for the authority to discharge its duties and otherwise carry out the purposes of this chapter.
(b) The authority is charged with the responsibility of initiating and implementing comprehensive health care reform in West Virginia consistent with the health care reform principles specified in section three of this article and other provisions included within this chapter: Provided, That except as specifically designated by this article, the authority shall not be responsible for the day-to-day administration of any state health program. No person harmed or aggrieved by the action or inaction of a particular state health program shall have a right to appeal to the authority to challenge that action or inaction or to sue the authority for injuries resulting therefrom but shall appeal to the appropriate circuit court or file suit against the appropriate state health program. Specific responsibilities of the authority shall be to set policy guidelines and priorities for health care reform including, but not limited to:
(1) Quality assurance in the provision of health care services, and regulations and licensing regarding health care services, providers, and payors;
(2) Data collection, analysis, research and planning with respect to the state's health care system;
(3) Regulation, management, oversight and the development of rate setting methodologies for public and private health care purchasing in the state;
(4) The development of rate setting methodologies and oversight of the health insurance industry in the state;
(5) The promotion of health care networks of preventive, primary, secondary and tertiary care in the state;
(6) Planning and implementing methods to finance and contain the costs of the state's health care system, including, but not limited to, the development of rate setting and health care financing methodologies;
(7) Being the state's designated liaison with the federal government to implement at the earliest possible date policies and programs consistent with appropriate federal reforms;
(8) Overseeing state health programs' compliance with the state health plan;
(9) Dissemination to the public of information regarding the health status of West Virginians, the state's health care system, and state and federal reform.
(c) The authority shall be solely responsible for preparing, amending and/or modifying the state health plan in order to guide state health programs toward achieving the health care reform principles defined in section three of this chapter. The state health plan heretofore developed by the health care planning commission and approved by the governor shall remain in effect until amended or modified by majority vote of the authority. All state health programs and their regulatory activities shall comply with the provisions of the state health plan as prepared, amended, and/or modified by the authority: Provided, That any proposed amendments or modifications to the state health plan that contradict any specific provisions of this code and thus cannot be implemented with executive action shall be submitted to the Legislature in the form of proposed legislation. The authority shall promulgate procedural rules for amending and modification of the state health plan on or before the first day of September, one thousand nine hundred ninety-four.

§ 16A-1-8. Specific duties of the authority; deadlines.

(a) Advisory groups and task forces. -- On or before the first day of July, one thousand nine hundred ninety-four, the authority shall establish an advisory group to represent health care providers interests and concerns before the authority. The regional health advisory councils now in existence shall continue to serve as community health advisory committees, under the direction of the director of consumer affairs. On or before the first day of September, one thousand nine hundred ninety-four, the authority shall appoint a long-term care task force to develop a comprehensive state long-term care plan by the first day of September, one thousand nine hundred ninety-five, consistent with the goals and objectives defined in section thirteen of this article and the malpractice reform task force provided for in section fifteen of this article.

(b) State health programs. -- On or before the first day of September, one thousand nine hundred ninety-four, the authority shall determine the state health programs with policies, programs, services, duties or responsibilities relating to health or health care that shall be subject to the guidelines contained within the state health plan. Such programs shall include at a minimum, the department of health and human resources, the health care cost review authority, the division of workers' compensation, the public employees' insurance agency, the division of insurance, and the division of rehabilitation services. Each state health program shall ensure that its policies, programs, services, actions and expenditures are consistent with the provisions of this chapter, the state health plan, and other guidelines established by the authority.
(c) Policy recommendations. -- On or before first day of December, one thousand nine hundred ninety-four, the authority shall present a preliminary set of administrative and legislative recommendations to the governor and Legislature. On or before the first day of October, one thousand nine hundred ninety-five, the authority shall present a comprehensive set of specific administrative and legislative recommendations to the governor and the Legislature reasonably designed to:
(1) Assure that after the first day of January, one thousand nine hundred ninety-seven, all West Virginians will have access to appropriate health care services regardless of financial or health status: Provided, That this provision shall be construed to create an entitlement of health care services for any particular individual at any time;
(2) Increase the availability of primary and preventive care services and professionals in underserved areas of the state;
(3) Slow or reduce to the general inflation rate the rate of health care cost increases for all payors;
(4) Improve the health status of the citizens of this state;
(5) Increase the administrative efficiency and quality of state health programs;
(6) Maximize the opportunities presented by comprehensive federal health care reform initiatives; and
(7) Assure the quality, integration, and coordination of health care services.
The recommendations described in this subsection shall be accompanied by analyses of at least the following issues:
The effect and estimated future value of cost containment initiatives already implemented in state health programs and methods to institute further cost containment methods for such programs;
The advisability of instituting rate setting methodologies such as diagnostic related groups, resource-based relative value scales, and global budgets;
The extent to which capitated and other managed health care systems are available or potentially available in the state and specifically, whether such systems allows the state to provide medicaid coverage to the working poor without increasing the overall costs of the program;
The extent to which state-funded health professions schools have helped increase access to primary and preventive care services in underserved areas of the state and recommendations regarding the same;
The need, if any, for reform of the health insurance industry and the corresponding regulatory framework in this state.
(d) Practice guidelines demonstration project. -- On or before the first day of January, one thousand nine hundred ninety-five, the authority shall propose by legislative rule a set of practice guidelines for obstetrical services. Upon approval by the legislative rule-making and review committee, these practice guidelines shall provide the basis for an affirmative defense to malpractice claims predicted on actions taken within those guidelines;
(e) Annual certificate of need capital allocation budget. -- On or before the first day of January, one thousand nine hundred ninety-five and each year thereafter, the authority shall specify in the state health plan a maximum annual statewide budget for capital expenditures requiring certificates of need. Said budget shall:
(1) Establish classes of certificates of need and the maximum aggregate amount of certificates that may be issued within each class each year;
(2) Support the regionalization of high technology and specialty care and the development of primary care and other community-based, low-cost services;
(3) Support the establishment and use of integrated health care networks;
(4) Provide the exceptions in emergency circumstances that pose a threat to public health; and
(5) Provide for the application of the budget and certificate of need allocation by the health care cost review authority pursuant to article two-d, chapter sixteen of this code.
If necessary, the authority shall declare a moratorium on approval of certain or all classes of certificates of need for up to a six month period in order to effectively implement this subsection. The health care cost review authority shall have no discretion to approve capital expenditures in excess of its capital expenditure budget allocation. In no event shall the annual capital expenditure cap exceed the average of total capital expenditures subject to certificate of need review for the proceeding three fiscal years.
(f) Statewide global budget target. -- On or before the first day of December, one thousand nine hundred ninety-five and each year thereafter, the authority shall specify in the state health plan a projected statewide global budget target for total annual health related expenditures in the state for the fiscal year 1996-97, detailing appropriate categories of expenditures and describing the state health programs involved in administering or regulating such expenditures. For fiscal year 1997-98 and each year thereafter, each state health program shall take all steps necessary to ensure that the portion of the statewide global budget over which it has administrative or regulatory authority shall not exceed the statewide budget so specified.
(g) Self-referral guidelines. -- On or before the first day of July, one thousand nine hundred ninety-five, the authority shall establish directives for health care providers regarding prohibited patient referrals between health care providers and entities providing health care services to protect the citizens of West Virginia from unnecessary and costly health care expenditures.
§ 16A-1-9. Management of state health programs and facilities.
(a) The following cost containment strategies must be implemented by state health programs:
(1) Medicaid, PEIA, and workers compensation shall consolidate certain administrative functions, including, but not limited to, common claim forms, standardized policies and procedures, shared hospital bill audit mechanisms, and data reporting on or before the first day of July, one thousand nine hundred ninety-four.
(2) Medicaid shall, on or before the first day of July, one thousand nine hundred ninety-four:
(i) Implement a statewide capitated managed care system for behavioral health care services that maximizes opportunities for federal funding for such services without increasing total state behavioral health expenditures; and
(ii) Submit to the federal government necessary waiver requests to implement a capitated managed care demonstration project for families and the elderly.
(3) PEIA shall develop and implement a capitated managed care option for enrollees by the first day of July, one thousand nine hundred ninety-five.
(b) The Legislature hereby finds that there is a critical need for enrollees in state health programs to have adequate access to primary care services; that there is a severe shortage of primary care health professionals in underserved areas of the state; and that there is increasing difficulty in recruiting and retaining primary care professionals as demand for their services increases nationwide. The Legislature further finds that there is substantial need for state health programs to adequately reimburse health professionals for primary care services provided their enrollees. Accordingly, on or before the first day of July, one thousand nine hundred ninety-four, PEIA, medicaid and any other state health programs designated by the authority to comply with this subsection shall adopt enhanced reimbursement rates and other appropriate mechanisms specifically designed to encourage primary care professionals to practice in the state over the long term so that the enrollees of state programs can obtain primary care services.
(c) In recognition of the significant costs associated with the the public management and operation of state health facilities and the need to make better use of state and federal funds funding and potentially funding the essential services provided by those facilities, notwithstanding any other provision in this code to the contrary, the secretary of the department of health and human resources shall on or before the first day of July, one thousand nine hundred ninety-six, close, sell, lease, or otherwise transfer to the private sector any state health facility, or otherwise arrange for the private sector administration or operation of said facility by contract or any other means: Provided, That prior to any transfer of patients or residents from a state health facility occurring as a result of any such closure, sale, lease, contract or other form of transfer made pursuant to this subsection, the secretary must have a detailed plan providing for the appropriate care, placement and movement of said patients or residents: Provided, however, That any person or entity to whom a state health facility is sold, leased or otherwise transferred pursuant to this subsection shall be exempt from the provisions of subsection (g), section five, article two-d, chapter sixteen with respect to the addition or construction of nursing beds within a thirty-mile radius of said state health facility, not to exceed the number of such beds filled by residents or patients in said facility immediately preceding said sale or transfer: Provided further, That all assets not sold, leased, or otherwise transferred or conveyed to the private sector shall be declared and treated as surplus state property.

§ 16A-1-10. Executive secretary for health care boards; task force on health profession licensing boards.

(a) The Legislature hereby finds that the primary purpose and function of the state's health profession licensing boards is to protect the public from inappropriate personal health care services. The Legislature further finds that the currently fragmented system of staffing health profession licensing boards is inefficient and fails to adequately protect the public from inappropriate health care practices in that some boards have no professional staff to help them conduct their business, have limited accessibility to the public, respond only to complaints and fail to actively monitor their licensees. In addition, the fragmentation of health profession licensing boards impedes the collection of health professions data essential to the planning and implementation of health care reform contemplated by this chapter. The Legislature further finds that in certain instances the consolidation of the management and staffing of the health profession licensing boards will create efficiencies that will enable said boards to have more resources and fulfill their public responsibility to protect and inform the public.

(b) On or before the first day of August, one thousand nine hundred ninety-four, the authority shall appoint the executive secretary for health profession licensing boards provided in section fifteen, article one, chapter thirty of this code, who shall report to the authority's director of administration. The first task of the executive secretary shall be to appoint a task force on health care licensing boards composed of representatives of health care providers, existing health profession licensing boards and consumers. The task force, which shall be chaired by the executive secretary, shall recommend ways to implement the provisions of this section and otherwise improve the effectiveness and efficiency of the health profession licensing boards.
(c) On or before the first day of January, one thousand nine hundred ninety-five, the task force shall present recommendations and appropriate legislation to the Legislature and governor that is designed to:
(1) Define and coordinate language, purpose and public service orientation of practice acts for the various state health profession licensing boards;
(2) Require consistent record keeping and reporting for health profession licensing boards;
(3) Subject to section seventeen, article one, chapter thirty of this code, require boards, providers, law enforcement agencies and courts to report actual and possible medically related violations to health profession licensing boards within specified time limits;
(4) Provide consumer access to specified information from health profession licensing boards;
(5) Provide health profession licensing boards with broader disciplinary responsibilities and options;
(6) Provide protection for health profession licensing board members, providers and consumers who provide information in good faith;
(7) Provide for improved funding of health profession licensing boards;
(8) Create a complaint and feed-back system which covers all health profession licensing boards;
(9) Evaluate classes of unlicensed providers for licensing and accreditation;
(10) Establish licensing for ambulatory care, urgent care, nursing care, home health care and free-standing health care;
(11) Merge health profession licensing boards for similar health care providers;
(12) Require health profession licensing boards to develop and use assessment processes;
(13) Require continuing education for relicensing; and
(14) Plan for the appropriate consolidation of health profession licensing board staff.
(d) The authority shall assess each health profession licensing board an appropriate amount of funds to adequately fund the work of the task force. On or before the first day of July, one thousand nine hundred ninety-five, the administration of all health profession licensing boards shall be consolidated consistent with the task force's recommendations under the direction of the executive secretary.
(e) The uniform health professionals' data system previously established under the commissioner of the bureau of public health shall be continued under the executive secretary. The data to be collected and maintained shall include, but not be limited to, the following information about each health professional: His or her name; profession; the area of the state where practicing; educational background; employer's name; and number of years practicing within the profession. The health care profession licensing boards, and any successor or successors thereto, shall collect the data on health professionals under their jurisdiction on an annual basis and in the format prescribed by the executive secretary. Each such board shall be required to pay to the authority an amount, to be determined by the authority, to cover expenses reasonably incurred by or on behalf of the executive secretary in establishing and maintaining the uniform health professionals' data system required by this section. The executive secretary shall publish or cause to be published annually and make available upon request, a report setting forth the data which was collected the previous year, areas of the state which the collected data indicates have a shortage of health professionals, and projections, based on the collected data, as to the need for more health professionals in certain areas.
§ 16A-1-11. Certification of health care networks.
(a) It is hereby the intent of the Legislature that the authority, on behalf of the state, become actively involved in the development of cooperative and collaborative efforts by local health care providers to ensure cost effective access to quality health care services for the citizens of this state. This action is imperative not only to make the best use of existing health professionals and facilities, but also to retain those resources in the future.
(b) On or before the first day of July, one thousand nine hundred ninety-five, the authority shall develop and implement a system for certification of health care networks. A health care
network is a locally based organization of health care, education and support service providers, which promotes a cooperative and collaborative approach to the delivery of health care services and provides for the complete range of health care and, in some cases, social needs of its patients, and which is planned, established and operated on a community level within the framework of a state plan. In order to be so designated, a network must:
(1) Access, costs and quality of health care services for a geographically-defined population;
(2) Provide or arrange for the delivery of integrated preventive, primary care and acute care services; and
(3) Provide or arrange for the delivery of other health, social and transportation services as deemed necessary by the legally recognized organization.
Health care networks must meet such other criteria as are set forth by the authority in the state health plan.
§ 16A-1-12. Antitrust; state action.
(a) The Legislature hereby specifically finds that the integration of and cooperation and collaboration among health care providers, including those that would otherwise be in competition, often provide more benefits than the competition that would otherwise be provided and, consequently, with the determinations made by the authority pursuant to this article, justify exemption from the antitrust provisions of state and federal law.
(b) It is the intent of this article to require the state, through the authority, to provide direction, supervision and control over health care networks certified pursuant to section eleven of this article to such an extent as to provide immunity under federal antitrust laws to the health care organizations or practitioners so certified.
(c) The antitrust provisions set forth in article eighteen, chapter forty-seven of this code do not apply to discussions authorized under this article. Any contract, business or financial arrangement or other activity, practice or arrangement involving health care providers or other persons that is approved by the authority under this article does not constitute an unlawful contract, combination or conspiracy in unreasonable restraint of trade or commerce. Approval by the authority is an absolute defense against any action under the state antitrust laws.
(d) Nothing in this article gives the authority or any person the right to require a health care provider or other person to discuss or enter into a health care network or to preclude a health care provider or other person from attempting to collaborate or cooperate for the provision of health care services independent of the certification process defined by the authority. This article has no effect on any cooperative agreement made, cooperative action entered into or network formed by two or more health care providers or other persons who are not acting under this article.

§ 16A-1-13. Long-term care.

(a) The authority shall be responsible for comprehensive long-term care planning and shall develop and submit to the governor and the Legislature, not later than the first day of September, one thousand nine hundred ninety-five, a comprehensive state long-term care plan. The long-term care plan shall set forth goals and objectives taking into consideration a full range of long-term care services and activities and policy with respect to the following:

(1) A system for long-term support based upon an individual's functional needs and not categorical labels;
(2) Policies, programs and resource allocation recommendations that reflect a shift away from providing traditional care in medically oriented facilities toward providing support in natural environments whenever possible;
(3) The development of an effective system of service coordination for long-term care consumers that provides for varying levels of support depending upon the needs of the individual;
(4) Recommendations for the development, integration and coordination of services, including, but not limited to, the following:
(A) Case management;
(B) In-home services;
(C) Care-giver support;
(D) Alternative community living;
(E) Rehabilitation services;
(F) Mental health services;
(G) Transportation services;
(H) Assistive technologies;
(I) Long-term care facilities, in-patient mental health facilities and rehabilitation facilities;
(J) Education; and
(K) Other services to meet people's basic needs;
(5) Strengthening informal support systems as part of long-term care; and
(6) Emphasis on consumer participation and direction.
(b) The authority may from time to time engage in research and demonstration activities for the purpose of designing, testing and implementing statewide strategies for long-term care service development in accordance with the long-term care plan.

§ 16A-1-14. Wellness; community-based health promotion programs.
(a) The Legislature hereby specifically finds that good health is greatly influenced by social and economic factors and individual lifestyles and behaviors and that organizational and institutional changes must be made to support individual change.

(b) The authority shall develop or cause to be developed, not later than the first day of January, one thousand nine hundred ninety-five, a plan for educating West Virginians on proper access and use of the health care system and for encouraging West Virginians to adopt and maintain healthful lifestyles. Such plans, among other measures, shall encourage people to:
(1) Establish a relationship with a primary care provider before they get sick;
(2) Assure continuity of care by remaining with one primary care provider unless there is a substantial reason to change providers;
(3) Use a primary care provider rather than a hospital emergency room for nonemergency health care problems;
(4) Follow a recommended schedule of preventive care;
(5) Follow the advice and instructions of their health care providers;
(6) Take an active, informed role in the treatment process;
(7) Learn principles of self-care; and
(8) Complete advance directive documents such as those provided for in articles thirty and thirty-a, chapter sixteen of this code.
(c) The authority shall also support and encourage health promotion and wellness in the workplace by providing educational and administrative support to entities, including, but not limited to, any nonprofit corporation organized to promote wellness among private employers, to promote, coordinate, assist and disseminate successful wellness initiatives and shall promote and support the creation and maintenance of organized community-based health promotion programs throughout the state.
§ 16A-1-15. Task force on tort and liability system.
Not later than the first day of September, one thousand nine hundred ninety-four, the authority shall appoint a task force to study and make recommendations on ways to improve the tort liability system as it effects the state's health care system. Such task force shall evaluate and quantify where possible the extent to which various tort reform proposals, including, but not limited to, mandatory scheduling conferences within time limits, reduction in the statutes of limitation and other procedural reforms, changes in prefiling discovery to include only those parties directly involved, alternative dispute resolution mechanisms for health care negligence suits, incentives for early resolution through the creation of an accelerated compensation event system; the manner in which practice guidelines may be used as standards of care in malpractice cases, a sliding scale for attorney fees; revision of the collateral source rules, mechanisms to limit the adverse effects of derivative liability theories for physicians and other health care providers and facilities working with midlevel practitioners, and such other matters the task force may deem appropriate, may have an impact on the availability, quality and affordability of health care services in the state. The task force shall present its recommendations to the governor and the Legislature on or before the first day of October, one thousand nine hundred ninety-five.
ARTICLE 2. PUBLIC HEALTH SYSTEM.
§ 16A-2-1. Short title.
This article is the "Public Health System Act of 1994."
§ 16A-2-2. Legislative findings and purposes.
The health problems of West Virginia and pending federal reforms demand that health care reform in this state include an aggressive public health initiative that redefines the mission and role of public health. Specifically, the state's public health system must focus on providing core public health functions and those population-based services and preventive population-based services identified by the federal centers for disease control and prevention and the institute of medicine. As the public health role and mission are redefined and as a reformed health care delivery system is implemented, many individuals currently receiving primary care services from local health departments will receive such care from other health care providers as such providers become available to such individuals. Care must be taken in a redesigned public health system to assure that individuals will not lose needed services and our public health system does not suffer because of any change of focus or method of funding of local health services.
The purpose of this legislation is to promote the achievement of all the above through the establishment of an efficient and coordinated public health system in which local boards of health, regional public health networks, the public health system advisory council and the bureau of public health work together to achieve the most effective public health system possible.
§ 16A-2-3. Definitions.
(a) "Core public health functions" means the assessment of community health status and available resources; policy development resulting in efforts to achieve better health; and assuring that needed services are available, accessible and of acceptable quality.
(b) "Population-based services" means services that focus on the identification of health threats, community health protection, screening and prevention services, health promotion programs and services that improve access to care.
(c) "Preventive population-based services" means services that target the health status of the entire population, as opposed to health care services which target individuals and which are usually administered after a person becomes ill.
§ 16A-2-4. Public health system advisory council .
There is hereby created a public health system advisory council (hereinafter "council"). The council shall be appointed by the commissioner of the bureau of public health in the department of health and human resources, who shall also appoint the council's chair. The members of said council shall reside throughout the state and represent diverse segments of the public. The council members shall serve without compensation, except they may be reimbursed for reasonable expenses incurred in the performance of their duties. The department of health and human resources shall, within funds available, provide the council with such staff support, information and consultants as the council deems necessary. Meetings of the council shall be called by the chair.
The council shall advise the health care authority and the commissioner of the bureau of public health in the department of health and human resources as to the development of a public health system and engage in activities to promote that development. Specifically, the council shall recommend to the commissioner:
(a) The number and geographic boundaries of regional public health networks to be established throughout the state;
(b) The appropriate roles and relative authority of the bureau of health, regional public health networks and local boards of health in this state's public health system;
(c) The means of funding such networks;
(d) The training needs required by those networks, local health departments and others involved in public health; and
(e) Such other matters as the council deems advisable to promote the development of a public health system envisioned by this act.
§ 16A-2-5. Local health boards.
In addition to duties performed by a local board of health under articles two and two-a, chapter sixteen of this code, each local health board shall coordinate its activities with its regional public health network; conduct community health assessment and assurance activities; develop local policy recommendations based on its findings; deliver certain population-based services; and provide other core public health functions.
Each local board of health shall appoint a person to serve as a member of its regional public health network, except a combined local board of health created under the authority of section three, article two, chapter sixteen of this code, shall appoint as many persons as members of its regional public health network as there are jurisdictions which formed such combined local boards.
If by the first day of March, one thousand nine hundred ninety-five, a local board of health has not made its appointment or appointments to its regional public health network, the department of health and human resources shall make such appointment or appointments who shall serve until replaced by appointment by the local board of health.
§ 16A-2-6. Regional public health networks.
The department of health and human resources, in consultation with the public health system advisory council, shall create regional public health networks to facilitate the development of a model statewide public health system. A regional public health network shall be a subdivision of the state and shall execute the public health policies of the department of health and human resources, so far as applicable to its region, and shall have such powers as are necessary to accomplish within its region the public health system purposes of this act.
The regional health networks shall consist of members appointed by each local board of health located within the applicable region in accordance with sections of this article. The commissioner of the bureau of public health in the department of health and human resources shall appoint the chairs of regional public health networks. The regional public health network chairs shall be appointed for three-year terms, except that one third of the first set of chairs appointed shall be appointed for one year and one third of the first set of chairs shall be appointed for two years. Chairs may be reappointed.
The regional public health networks shall receive such funding as is made available by the state and other sources and each such network shall expend such funds toward the development and maintenance of its regional public health network and for local health services within its region.
ARTICLE 3. INFORMATION SYSTEM; REQUIREMENTS.
§ 16A-3-1. Information system.
(a) The authority shall develop an information system that collects and provides data with which the authority can evaluate health care reform initiatives and the effectiveness and efficiency of health care services in the state. The authority shall be responsible for coordinating data systems, analyzing studies and developing and disseminating information to policy makers, health care providers and the public.
(b) The authority may carry out its responsibilities under this article either directly or indirectly by delegating to another state agency or by contracting with any public, private or public-private entity.
§ 16A-3-2. Collection of data; information to be provided.
(a) The authority shall collect data from health care providers, health insurers and individuals in the most cost-effective manner, which does not unduly burden the providers, insurers or individuals. The authority may require health care providers and health insurers to collect and provide, subject to the provision of this article requiring confidentiality, patient health records and to cooperate in other ways with the data collection process. Each payor of health care services in the state shall furnish any information reasonably required by the authority. Such information shall be provided by electronic media, tape or diskette if available or as otherwise requested by the authority.
(b) Each agency of state government required to submit a report regarding any aspect of health care to the Legislature or the governor, or both, shall, at the same time, submit a copy of such report and source data in electronic and hard copy form to the authority.
(c) The state health care cost review authority shall provide to the authority all data it receives regarding hospital discharges, nursing home occupancy rates, ambulatory-surgical data and similar information. In addition to information currently received, the health care cost review authority shall require each hospital to provide it with such other information as the authority may reasonably request to carry out its duties. The insurance commissioner of West Virginia shall provide to the authority any information upon request and shall enforce the applicable requirements of this section. The university of West Virginia board of trustees and the board of directors of the state college system shall provide to the authority all information on health profession students and residents as the authority reasonably requests. If such information is not available, the boards shall take necessary steps to compile such information.
(d) Each agency of state government, including those specified in subsection (d) of this section, shall provide the authority with any data or information requested, including data that are considered confidential or otherwise protected from external release. Such data shall be subject to the same state and federal statutory provisions as are applicable to the agency from which the data was originally obtained. Data which is otherwise protected by statute shall not be further transferred to any entity by the authority without a separate written agreement with the agency which originally provided the data to the authority.
(e) All data collected and maintained by any state agency relating to health care or any aspect of health care delivery in West Virginia, and any compilation, summary or analysis thereof or other information in connection therewith, shall be the property of the authority and shall be collected, maintained and used by such state agencies only in accordance with the rules, policies or guidelines established by the authority.
§ 16A-3-3. Confidentiality.
(a) The authority shall not release data that identifies individuals by name except as specifically required by this code or by court order. The authority may release data identifying individuals by number or similar methods and other data not generally available to the public, to researchers affiliated with university research centers or departments who are conducting research on health outcomes, practice guidelines and medical practice style and to researchers working under contract with the authority. The authority may also release such data to any other person who the authority determines is appropriate to receive such information: Provided, That such persons must agree to protect the confidentiality of such data according to this article.
(b) Summary data derived from any of the data collected by or for the authority may be released in studies produced by the authority or by any of its contractors, cosponsors and research affiliates.
(c) The authority shall adopt rules to establish criteria and procedures to govern access to and the use of data collected by or for the authority. Records regarding individuals shall not be subject to release under article one, chapter twenty-nine-b of this code or under any other freedom of information provisions.
§ 16A-3-4. National health status indicators.
The authority shall implement or cause to be implemented a periodic analysis and publication of data necessary to measure progress toward objectives for at least ten of the priority areas of the national health objectives and participate or cause the bureau of public health of the department of health and human resources to participate in the development and implementation of a national set of health status indicators appropriate for federal, state and local health agencies.
§ 16A-3-5. Study of administrative costs.
The authority shall study costs and requirements incurred by health insurers, group purchasers, health care providers and, to the extent possible, individuals that are related to the collection and submission of information regarding health care to the state and federal government, insurers and other third parties. The authority shall implement by the first day of July, one thousand nine hundred ninety-five, any reforms that may reduce these costs without compromising the purposes for which the information is collected.

§ 16A-3-6. Health care medical records, confidentiality; criminal penalties.

(a) Any health care provider who has custody of medical records may reveal specific medical information contained in those records to the individual on whom the record is kept, to the individual's agent or representative, or as otherwise specifically authorized in this code.

(b) Any health care provider who has custody of health care records may not reveal specific health care information contained in those records to any person unless authorized by the individual on whom the record is kept.
(c) Subsection (b) of this section does not apply to a health care provider who has custody of medical records if the provider is:
(1) Performing health care services or allied support services for or on behalf of a patient;
(2) Providing information requested by or to further the purpose of a medical review committee, accreditation board or commission or in response to a court order;
(3) Providing information required to conduct the proper activities of the health care provider;
(4) Providing information at the request of a researcher for medical and health care research under a protocol approved by an institutional review board or as requested by the authority;
(5) Revealing the contents of health care records under circumstances where the identity of the patient is not disclosed, either directly or indirectly, to the recipient of the records;
(6) Providing information requested by another health care provider of medical care for the sole purpose of treating the individual on whom the record is kept;
(7) Providing information to a third party payor for billing purposes only;
(8) Providing information to a nonprofit health service plan or a blue cross or blue shield plan to coordinate benefit payments under more than one sickness and accident, dental, or hospital and medical insurance policy other than an individual policy; or
(9) Providing information to organ and tissue procurement personnel in accordance with any applicable laws or rules at the request of a physician for a patient whose organs and tissue may be donated for the purpose of evaluating the patient for possible organ and tissue donation.
(d) The knowing breach of the confidentiality of any health care records by a health care provider or anyone who obtains access to personally identifiable health care information shall be a misdemeanor, punishable by a fine of two thousand dollars.

CHAPTER 18C. STUDENT LOANS; SCHOLARSHIPS AND STATE AID.

ARTICLE 3. HEALTH PROFESSIONALS STUDENT LOAN PROGRAMS.

§ 18C-3-1. Health education loan program; establishment; administration; eligibility; penalty for nonperformance of loan terms.

(a) Legislative findings. -- The Legislature finds that there is a critical need for additional practicing health care professionals in West Virginia. Therefore, there is hereby created a rural health education ~~student~~ loan program to be administered by the senior administrator of the higher education central office and under the jurisdiction of the vice chancellor for health sciences. The purpose of this program is to provide a loan for ~~tuition and fees~~ educational costs to students enrolled in health education programs at ~~West Virginia~~ institutions of higher education in this state, whether public or private, who intend to practice their profession in underserved areas in the state following completion of their studies or in a health care specialty in which there is a shortage of health professionals as determined by the health care authority. The loans are not to be awarded on the basis of the financial need of the student, rather the loans are to be awarded based on the need of the state to retain all levels of health professionals in all areas of the state and in all specialties and where possible to complement the rural health initiative established in article sixteen, chapter eighteen-b of this code.

(b) Establishment of special account. -- There is hereby established a special revolving fund account under the board of trustees in the state treasury to be known as the rural health education ~~student~~ loan fund which shall be used to carry out the purposes of this section. The fund shall consist of: (1) All funds on deposit in the ~~medical student~~ health education student loan fund in the state treasury on the effective date of this section, or which are due or become due for deposit in the fund as obligations made under ~~the~~ any previous ~~enactment~~ enactments or reenactments of this section; (2) thirty-three percent of the annual collections from the medical education fee established by section four, article ten, chapter eighteen-b of this code, or such other percentage as may be established by the board of trustees by legislative rule subject to approval of the Legislature pursuant to the provisions of article three-a, chapter twenty-nine-a of this code: Provided, That funds derived from the health education fee shall be used only for loans to qualified health education students at the school where the fee was collected; (3) appropriations provided by the Legislature; (4) penalties assessed to individuals for failure to perform under the terms of a loan contract as set forth under this section, and repayment of any loans which may be made from funds in excess of those needed for loans under this section; (5) amounts provided by medical associations, hospitals or other medical provider organizations in this state, or by political subdivisions of the state, under an agreement which requires the recipient to practice his or her health profession in this state or in the political subdivision providing the funds for a predetermined period of time and in such capacity as set forth in the agreement; and (6) other amounts which may be available from external sources. Balances remaining in the fund at the end of the fiscal year shall not expire or revert. All costs associated with the administration of this section shall be paid from the health education ~~student~~ loan fund.
(c) Eligibility and forgiveness requirements for rural health education ~~student~~ loan. -- An individual is eligible for a health education ~~student~~ loan if the individual: (1) Is enrolled or accepted for enrollment at the West Virginia University school of medicine, Marshall University school of medicine, the West Virginia School of Osteopathic Medicine in a program leading to the degree of medical doctor (M.D.) or doctor of osteopathy (D.O.) or any other health professional school in this state approved by the senior administrator: Provided, That the individual has not yet received one of these degrees and is not in default of any previous student loan; (2) meets the established academic standards; and (3) signs a contract to practice his or her health profession in an underserved area of the state or in a health care specialty in which there is a shortage: Provided, however, That for every year that an individual serves in an underserved or shortage area, ~~ten~~ the actual educational costs and fees up to twenty thousand dollars of the loan granted to the individual will be forgiven.
Loans ~~shall~~ may be awarded by the ~~senior administrator, with~~ ~~the advice of the board of trustees~~ director of financial aid of an approved school of medicine or other health profession school with the approval of the senior administrator and in accordance with such rules as may be adopted by the board of trustees on a priority basis from the pool of all applications with the first priority being a commitment to serve in an underserved area of the state or in a ~~medical~~ health care specialty in which there is a shortage of practitioners in the state as determined by the ~~state division of health at the time the loan is granted~~ health care authority with the advice of the office of community and rural health services. A loan from the fund shall be limited to the cost of education as determined by the applicable health profession school up to twenty thousand dollars per year, whichever is less.
At the end of each fiscal year, any individual who has received a rural health education ~~student~~ loan and who has completed the education for which the loan was received shall submit to the board of trustees a notarized, sworn statement of service on a form provided for that purpose. Upon receipt of such statement in proper form and verification that the individual has complied with the terms under which the loan was granted, the board of trustees shall cancel an outstanding amount of the loan equal to the average annual amount of the loan received up to ~~ten~~ twenty thousand dollars ~~of the outstanding~~ ~~loan~~ for every full twelve consecutive calendar months of such service.
If an individual, upon completion of the education for which a loan was received pursuant to the provisions of this section, fails to perform the service, fails to submit the required statement of service, or submits a fraudulent statement, in addition to other penalties, the individual is in breach of contract resulting in a penalty of ~~three~~ two times the amount of the outstanding balance of the loan granted. If at the end of one year the loan is not paid, the board of trustees shall impose an interest charge of three percent higher than the prime lending rate.
A loan recipient who subsequently fails to meet the academic standards necessary for completion of the course of study under which the loan was granted or who fails to complete the course of study under which the original loan was granted is liable for repayment of the loan amount under the terms for the repayment of loans established by the board of trustees at the time the loan contract was executed.
(d) Loans granted under medical student loan program. -- Any student granted a medical student loan or rural health education loan ~~under the provisions of this~~ ~~section prior to the effective date of the amendment and~~ under any enactment or reenactment of this section shall continue ~~reenactment of this section at the second extraordinary~~ ~~session of the Legislature in the year one thousand nine hundred~~ ~~ninety~~-~~one continues~~ to be eligible for consideration for receipt of such a loan, and/or obligated to repay such loan, as the case may be, under the prior provisions. Thereafter, the senior administrator may utilize any funds remaining in the former health education student loan fund or the medical student loan fund after all loan grants have been disposed of for the purposes of the ~~medical student~~ rural health education loan program. An individual is eligible for continuation of the medical student loan ~~consideration~~ if the individual demonstrates financial need, meets established academic standards and is enrolled or accepted for enrollment at one of the aforementioned schools of medicine in a program leading to the degree of medical doctor (M.D.) or doctor of osteopathy (D.O.): Provided, That the individual has not yet received one of these degrees and is not in default of any previous student loan: Provided, however, That the board of trustees shall give priority for the loans to residents of this state, as defined by the board of trustees.
At the end of each fiscal year, any individual who has received a medical student loan under prior enactments of this section and who has actually rendered services as a medical doctor or a doctor of osteopathy in this state in a medically underserved area or in a medical specialty in which there is a shortage of physicians, as determined by the division of health at the time the loan was granted, may submit to the board of trustees a notarized, sworn statement of service on a form provided for that purpose. Upon receipt of such statement in proper form and verification of services rendered, the board of trustees shall cancel five thousand dollars of the outstanding loan or loans for every full twelve consecutive calendar months of such service and may cancel up to twenty thousand dollars of the outstanding loan or loans for every full twelve consecutive calendar months of such service, such increased forgiveness and the amount of such increase to be determined by and with the approval of the vice chancellor for health sciences.
(e) Report by senior administrator. -- No later than thirty days following the end of each fiscal ye?ar, the senior administrator, through the vice chancellor, shall prepare and submit a report to the board of trustees for inclusion in the statewide report card required under section six, article two, chapter eighteen-b of this code to be submitted to the legislative oversight commission on education accountability established under section eleven, article three-a, chapter twenty-nine-a of this code. The report of the senior administrator shall include at a minimum the following information: (1) The number of loans awarded; (2) the total amount of the loans awarded; (3) the amount of any unexpended moneys in the fund; and (4) the rate of default during the previous fiscal year on the repayment of previously awarded loans.
(f) Promulgation of rules. -- The secretary of the department of education and the arts shall promulgate rules necessary for the operation of this section.
§ 18C-3-3. Rural health scholars program .
The rural health scholars program is hereby created, which program shall be administered by the senior administrator and under the jurisdiction of the vice chancellor for health sciences of the state university system in accordance with such policies as may be adopted by the board of trustees. Funds for the rural health scholars program shall be consolidated with the rural health education loan fund established pursuant to the provisions of section one of this article.
The program shall recognize outstanding students committed to practicing in rural areas or primary care specialties; shall reimburse students for up to two thousand dollars per year for expenses incurred by the student in working with a rural practitioner or attending research conferences and seminars regarding rural health care and primary care; and shall support such other activities as the vice chancellor and rural health advisory council considers necessary or appropriate to promote the recruitment and retention of students and health care providers in rural areas or primary care specialties.
§ 18C-3-4. Primary care support trust fund.
(a) There is hereby created in the state treasury a special fund under the board of trustees to be known as the primary care support trust fund. Five percent of all annual general revenue appropriations made to health profession schools in the state shall be placed in said fund by the board of trustees on an annual basis.
(b) Eighty percent of said funds are to be distributed to health profession schools on a formula basis designed by the board of trustees. In order to receive these funds, a health profession school must demonstrate to the vice chancellor's satisfaction, following consultation with the rural health advisory council, that the school has made substantial and effective efforts to support and encourage the continued placement and retention of primary care health professionals in underserved areas of the state.
(c) Twenty percent of said funds shall be awarded on a competitive grant basis to health profession schools based on applicants demonstrating and proposing exemplary efforts to support and encourage the continued placement and retention of primary care health professionals in underserved areas of the state.
CHAPTER 30. PROFESSIONS AND OCCUPATIONS.

ARTICLE 1. GENERAL PROVISIONS.

§ 30-1-15. Office of executive secretary of the health profession licensing boards; appointment of executive secretary; duties.

The office of the executive secretary of the health profession licensing boards ~~is hereby~~ created by chapter one hundred two, acts of the Legislature, regular session, one thousand nine hundred seventy-seven, is hereby continued under the health care authority established by section five, article one, chapter sixteen-a of this code. The health profession licensing boards shall include, but not be limited to, those boards provided for in articles ~~two-a~~ four, five, six, seven, seven-a, eight, ten, fourteen, sixteen, seventeen, twenty, twenty-one, twenty-five and twenty-six of chapter thirty of this code. Additional health licensing boards may be added by action of the health care authority. Notwithstanding any other provision of this code to the contrary, the office space, personnel, records and like business affairs of the health profession licensing boards shall be within the office of the executive secretary of the health profession licensing boards. To the extent needed as defined by the executive secretary, the secretaries of each of the health profession licensing boards shall coordinate purchasing, record keeping, personnel, use of reporters and like matters under the executive secretary in order to achieve the most efficient and economical fulfillment of their functions. The executive secretary shall be appointed by the ~~director of~~ health care authority and shall report to the director of administration of the authority. The executive secretary shall keep the fiscal records and accounts of each of the boards. The executive secretary shall keep the director informed as to the needs of each of the boards. The executive secretary shall coordinate the activities and efforts of the boards with the ~~activities of the health resources advisory~~ ~~council~~ state health plan and other policies of the health care authority and shall see that the needs for health ~~manpower~~ care professionals perceived by the boards are communicated to the ~~health resources advisory council~~ health care authority. The executive secretary shall keep any statistics and information on health professions, collected by or ~~for~~ the boards and shall make such statistics and information available to the ~~health resources~~ ~~advisory council~~ health care authority to aid it in carrying out its responsibilities.

§ 30-1-17. Liability limitations of professionals reporting provider negligence, impairment or incompetence to peer review committees and professional standards review committees; reporting results of litigation to committees; procedure for imposing penalties.

(a) Any member of a professional group or organization covered by this chapter, including, but not limited to, doctors of medicine, doctors of chiropractic, doctors of veterinary medicine, osteopathic physicians and surgeons, doctors of dentistry, pharmacists, attorneys-at-law, real estate brokers, architects, professional engineers, certified public accountants, public accountants, registered nurses, or licensed practical nurses, who, pursuant to any rule promulgated by the applicable governing board for that profession, or pursuant to the rules, regulations or by-laws of any peer review organization, reports or otherwise provides evidence of the negligence, impairment or incompetence of another member of his or her profession to the governing board for such profession or to any peer review organization shall not be liable to any person for making such a report if such report is made without actual malice and in the reasonable belief that such report is warranted by the facts known to him or her at the time.

(b) In the event a claim or cause of action is asserted against a member of any profession included in this chapter, whether an individual or an entity, as a result of the filing of a report by such member pursuant to the provisions of this chapter, or the rules and regulations of the applicable governing board for that profession, or pursuant to rules, regulations or by-laws of any peer review organization, and such claim or cause of action is subsequently dismissed, settled or adjudicated in favor of the person or entity making the required report, the person or persons who initiated the claim or action shall be liable for all attorneys fees, costs and expenses incurred by the reporting professional.
(c) Within thirty days of the dismissal, settlement, adjudication or other termination of any claim or cause of action asserted against any professional reporting under the provisions of this chapter, the person or persons filing such claim or cause of action shall submit to the applicable governing board the following information:
(1) The names of the parties involved;
(2) The name of the court in which the action was filed, if applicable;
(3) The bases and nature of the claim or cause of action; and
(4) The results of such claim or cause of action, including dismissal, settlement, court or jury verdict or other means of termination.
(d) The health care authority established by section one, article two, chapter sixteen-a of this code shall promulgate legislative rules pursuant to the provisions of chapter twenty-nine-a of this code, establishing procedures for imposing sanctions and penalties against any member of such profession who fails to submit to the board the information required by this section.
(e) The provisions of this section shall not preclude the application of any immunity protections which may be set forth under any article in this chapter.

NOTE: The purpose of the West Virginia Health Care Access and Reform Act of 1994 , is to take the first steps toward a comprehensive reform of the health care system in West Virginia. The Act establishes the West Virginia Health Care Authority to carry out the Act; requires the Authority to identify state health programs with policies, programs or responsibilities relating to health or health care and requires such programs to abide by the state health plan; requires the Authority to update the state health plan; requires the Authority to undertake specific actions and studies; requires the state agencies to undertake cost containment strategies, to establish reimbursement mechanisms to assist primary care providers in underserved areas, and to transfer state health facilities to the private sector; requires studies of long term-care and wellness issues; requires the authority to establish system for certifying health care networks and provides for anti-trust exemption for providers participating in such networks; requires the Authority to develop an information system from which evaluations can be made and on which decisions can be based and provides for confidentiality of data; places the executive secretary of health care boards under the Authority as eventual exclusive staff support to health profession licensing boards; establishes a rural health professions loan fund, a rural health scholars program, and a funding mechanism to encourage health profession schools to support rural primary care services; provides limitations on liability for persons reporting provider negligence.

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

Sections three and four, article three, chapter eighteen-c; chapter sixteen-a; and section seventeen, article one, chapter thirty are new; therefore, underscoring and strike-throughs have been omitted.