COMMITTEE SUBSTITUTE

FOR

H. B. 4054

(By Mr. Speaker, Mr. Chambers, and Delegate Burk)

(By Request of the Executive)
(Originating in the Select Committee on Health Care
Policies)
[February 21, 1994]

A BILL to repeal article one-a, chapter sixteen of the code of West Virginia, one thousand nine hundred thirty-one, as amended; to amend and reenact section nine, article sixteen, chapter five of said code; to amend and reenact section ten-b, article one, chapter sixteen of said code; to amend and reenact sections one, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen and fifteen, article two-d of said chapter sixteen; to amend and reenact section five, article three of said chapter sixteen; to amend and reenact section nineteen, article twenty-nine-b of said chapter sixteen; to further amend said code by adding thereto a new chapter, designated chapter sixteen-a; to amend and reenact section twenty-two, article five, chapter eighteen of said code; to amend and reenact section eight-a, article one, chapter eighteen-b 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 a new section, designated section three; to amend chapter twenty-nine-a of said code by adding thereto a new article, designated article three-c; to amend and reenact sections one, three, four-a, five, eight, ten, eleven and fifteen, article one, chapter thirty of said code; to further amend said article one by adding thereto five new sections, designated sections four-b, five-a, six-a, six-b, and seventeen; to amend and reenact section seventeen, article two, chapter thirty-three of said code; to amend and reenact section fifteen, article fifteen of said chapter thirty-three; to further amend said article fifteen by adding thereto a new section, designated section seventeen; to amend article sixteen of said chapter thirty-three by adding thereto a new section, designated section twelve; to amend article sixteen-a of said chapter thirty-three by adding thereto a new section, designated section fifteen; to amend and reenact sections three and four, article sixteen-c of said chapter thirty-three; to amend article sixteen-d of said chapter thirty-three by adding thereto a new section, designated section fourteen; to amend article twenty-four of said chapter thirty-three by adding thereto a new section, designated section seven-d; to amend article twenty-five of said chapter thirty-three by adding thereto a new section, designated section eight-a; and to amend article twenty-five-a of said chapter thirty-three by adding thereto a new section, designated section eight-a, all relating generally to health care reform; requiring third-party payors of health care services to pay the cost of childhood immunizations and vaccine administration; clarifying provisions of the health professionals data collection system; changing definitions of entities subject to certificate of need; amending provisions relating to the requirement for a certificate of need; clarifying exemptions from certificate of need process; amending criteria for certificate of need; amending procedural provisions for obtaining a certificate of need; providing injunctive relief and civil penalties; requiring free distribution of additional vaccines; requiring establishment of a childhood immunization advisory committee and specifying representation thereon; clarifying legislative rulemaking authority and providing for abrogation of rules that differ from requirements of the state health plan; providing a "West Virginia Health Care Access and Reform Act of 1994"; setting forth legislative findings and intent; providing definitions; creating a three member West Virginia health care authority and setting forth the membership, powers and duties of the authority; creating a health care authority management board and setting forth its membership, duties and responsibilities; requiring the health care authority to update the state health plan; requiring the health care authority to recommend a plan to provide universal coverage for health care services over time; amending the system of payment for health care providers; requiring the development of a uniform health benefits package; requiring expansion of coverage under medicaid for children and for hospice care, and permitting transfers from the medical services trust fund for this purpose; requiring the health care authority to develop a system for certifying health care networks; permitting three demonstration projects for health care networks; providing for technical assistance and grants to demonstration projects; exempting health care networks from coverage of federal and state antitrust laws; providing for planning for long-term care; providing for development of wellness programs; providing exemptions from collection of judgments for a homestead and certain pension plans; authorizing a task force on tort and liability system reform; requiring the development of a plan for a excess liability fund; establishing rural health recruitment strategies and studying the distribution of health care professionals in the state; providing for the development of school health programs and children's health programs; creating a public health system advisory council; focusing public health on core functions and population-based services; providing for development of community-based health programs; requiring the health care authority to develop an information system to provide basis for reform; requiring the authority to accumulate and health providers to disclose certain data; providing for confidentiality of information; providing criminal penalties for violating confidentiality of records; amending the qualifications for school nurses; expanding the information to be included in the higher education statewide report cards; establishing rural health loan program and rural health scholars program; providing a new legislative rule-making procedure for health related legislative rules; continuing the office of executive secretary of health professional licensing boards under the health care authority and expanding the boards under the jurisdiction of the secretary; providing a two-term limitation for members of health licensing boards; providing for transfers of certain funds of health licensing boards; expanding powers, duties and responsibilities of health licensing boards, members and officers; providing for certain immunity from civil liability for members of health profession licensing boards and "whistle-blower" protections for providers; and expanding the duties of the consumer advocate in the office of the insurance commissioner.

Be it enacted by the Legislature of West Virginia:

That article one-a, chapter sixteen of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be repealed; that section nine, article sixteen, chapter five of said code be amended and reenacted; that section ten-b, article one, chapter sixteen of said code be amended and reenacted; that sections one, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen and fifteen, article two-d of said chapter sixteen be amended and reenacted; that section five, article three of said chapter sixteen be amended and reenacted; that section nineteen, article twenty-nine-b of said chapter sixteen be amended and reenacted; that said code be further amended by adding thereto a new chapter, designated chapter sixteen-a; that section twenty-two, article five, chapter eighteen of said code be amended and reenacted; that section eight-a, article one, chapter eighteen-b of said code be amended and reenacted; 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 a new section, designated section three; that twenty-nine-a of said code be amended by adding thereto a new article, designated article three-c; that sections one, three, four-a, five, eight, ten, eleven and fifteen, article one, chapter thirty of said code be amended and reenacted; that said article one be further amended by adding thereto five new sections, designated sections four-b, five-a, six-a, six-b, and seventeen; that section seventeen, article two, chapter thirty-three of said code be amended and reenacted; that section fifteen, article fifteen of said chapter thirty-three be amended and reenacted; that said article fifteen be further amended by adding thereto a new section, designated section seventeen; that article sixteen of said chapter thirty-three be amended by adding thereto a new section, designated section twelve; that article sixteen-a of said chapter thirty-three be amended by adding thereto a new section, designated section fifteen; that sections three and four, article sixteen-c of said chapter thirty-three be amended and reenacted; that article sixteen-d of said chapter thirty-three be amended by adding thereto a new section, designated section fourteen; that article twenty-four of said chapter thirty-three be amended by adding thereto a new section, designated section seven-d; that article twenty-five of said chapter thirty-three be amended by adding thereto a new section, designated section eight-a; and that article twenty-five-a of said chapter thirty-three be amended by adding thereto a new section, designated section eight-a, all to read as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,

SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD

OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS,

OFFICES, PROGRAMS, ETC.

ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.

§ 5 - 16 - 9. Authorization to execute contracts for group hospital and surgical insurance, group major medical insurance, group prescription drug insurance, group life and accidental death insurance and other accidental death insurance; mandated benefits; limitations; awarding of contracts; reinsurance; certificates for covered employees; discontinuance of contracts.

(a) The director is hereby given exclusive authorization to execute such contract or contracts as are necessary to carry out the provisions of this article and to provide the plan or plans of group hospital and surgical insurance coverage, group major medical insurance coverage, group prescription drug insurance coverage and group life and accidental death insurance coverage selected in accordance with the provisions of this article, such contract or contracts to be executed with one or more agencies, corporations, insurance companies or service organizations licensed to sell group hospital and surgical insurance, group major medical insurance, group prescription drug insurance and group life and accidental death insurance in this state.

(b) The group hospital or surgical insurance coverage and group major medical insurance coverage herein provided for shall include coverages and benefits for X-ray and laboratory services in connection with mammograms and pap smears when performed for cancer screening or diagnostic services and annual checkups for prostate cancer in men age fifty and over. Such benefits shall include, but not be limited to, the following:
(1) Baseline or other recommended mammograms for women ages thirty-five to thirty-nine, inclusive;
(2) Mammograms recommended or required for women age forty to forty-nine, inclusive, every two years or as needed;
(3) A mammogram every year for women age fifty and over;
(4) A pap smear annually or more frequently based on the woman's physician's recommendation for women age eighteen and over; and
(5) A checkup for prostate cancer annually for men age fifty or over.
(c) The group life and accidental death insurance herein provided for shall be in the amount of ten thousand dollars for every employee. The amount of the group life and accidental death insurance to which an employee would otherwise be entitled shall be reduced to five thousand dollars upon such employee attaining age sixty-five.
(d) All of the insurance coverage to be provided for under this article may be included in one or more similar contracts issued by the same or different carriers.
(e) The provisions of article three, chapter five-a of this code, relating to the division of purchases of the department of finance and administration, shall not apply to any contracts for any insurance coverage or professional services authorized to be executed under the provisions of this article. Before entering into any contract for any insurance coverage, as herein authorized, said director shall invite competent bids from all qualified and licensed insurance companies or carriers, who may wish to offer plans for the insurance coverage desired. The director shall deal directly with insurers in presenting specifications and receiving quotations for bid purposes. No commission or finder's fee, or any combination thereof, shall be paid to any individual or agent; but this shall not preclude an underwriting insurance company or companies, at their own expense, from appointing a licensed resident agent, within this state, to service the companies' contracts awarded under the provisions of this article. Commissions reasonably related to actual service rendered for such agent or agents may be paid by the underwriting company or companies: Provided, That in no event shall payment be made to any agent or agents when no actual services are rendered or performed. The director shall award such contract or contracts on a competitive basis. In awarding the contract or contracts the director shall take into account the experience of the offering agency, corporation, insurance company or service organization in the group hospital and surgical insurance field, group major medical insurance field, group prescription drug field and group life and accidental death insurance field, and its facilities for the handling of claims. In evaluating these factors, the director may employ the services of impartial, professional insurance analysts or actuaries or both. Any contract executed by the director with a selected carrier shall be a contract to govern all eligible employees subject to the provisions of this article. Nothing contained in this article shall prohibit any insurance carrier from soliciting employees covered hereunder to purchase additional hospital and surgical, major medical or life and accidental death insurance coverage.
(f) The director may authorize the carrier with whom a primary contract is executed to reinsure portions of such contract with other carriers which elect to be a reinsurer and who are legally qualified to enter into a reinsurance agreement under the laws of this state.
(g) Each employee who is covered under any such contract or contracts shall receive a statement of benefits to which such employee, his or her spouse and his or her dependents are entitled thereunder, setting forth such information as to whom such benefits shall be payable, to whom claims shall be submitted, and a summary of the provisions of any such contract or contracts as they affect the employee, his or her spouse and his or her dependents.
(h) The director may at the end of any contract period discontinue any contract or contracts it has executed with any carrier and replace the same with a contract or contracts with any other carrier or carriers meeting the requirements of this article.
(i) The director shall provide by contract or contracts entered into under the provisions of this article the cost for coverage of children's immunizations services from birth through age sixteen years to provide immunization against the following illnesses: diphtheria, polio, mumps, measles, rubeola, rubella, tetanus, hepatitis-b, haemophilus influenzae-b and whooping cough. Additional immunizations may be required by the commissioner of the bureau of public health for public health purposes. Any contract entered into to cover these services shall require that all costs associated with immunization, including the cost of the vaccine, if incurred by the health care provider, and all costs of vaccine administration, be exempt from any deductible, per visit charge and/or copayment provisions which may be in force in these policies or contracts. This section does not require that other health care services provided at the time of immunization be exempt from any deductible and/or copayment provisions.
CHAPTER 16. PUBLIC HEALTH.

ARTICLE 1. STATE BUREAU OF PUBLIC HEALTH.

§ 16-1-10b. Establishment of a uniform health professionals data

collection system.

The commissioner of the bureau of public health shall establish a uniform health professionals data system to collect and maintain data on health professionals in this state established with the commissioner of the bureau of public health shall be continued under the executive secretary of the health profession licensing boards continued by section fifteen, article one, chapter thirty of this code. This 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 boards provided for under articles three, four, four-a, five, seven, seven-a, fourteen, fourteen-a, fifteen, sixteen, twenty, twenty-one, twenty-three and twenty-eight, chapter thirty of this code, 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 commissioner executive secretary and approved by the health care authority established by section five, article one, chapter sixteen-a of this code. Each such board shall be required to pay transfer to the bureau of health care authority an amount, to be determined by the commissioner health care authority, to cover the estimated expenses incurred by of or on behalf of the bureau of health executive secretary in establishing and maintaining the uniform health professionals data system required by this section: Provided, That this provision shall be construed to require the authority to detail plans for expenditure of funds before requiring the transfer of funds from the boards. The commissioner health care authority shall publish or caused 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 upon the collected data, as to the need for more health professionals in certain areas.

 ARTICLE 2D. CERTIFICATE OF NEED.
 § 16 - 2D - 1. Legislative findings.
It is declared to be the public policy of this state:
(1) That the offering or development of all new institutional health services shall be accomplished in a manner which is orderly, economical and consistent with the effective development of necessary and adequate means of providing for the institutional health services of the people of this state, and to avoids unnecessary duplication of institutional health services, and to contain or reduce contains or reduces increases in the cost of delivering institutional health services.
(2) That the general welfare and protection of the lives, health and property of the people of this state require that the type, level and quality of care, the feasibility of providing such care and other criteria as provided for in this article or by the state health planning and development agency pursuant to provisions of this article, needed in new institutional health services within this state be subject to review and evaluation before any new institutional health services are offered or developed in order that appropriate and needed institutional health services are made available for persons in the area to be served.
 § 16 - 2D - 2. Definitions.
As used in this article, unless otherwise indicated by the context:
(a) "Affected person" means:
(1) The applicant;
(2) An agency or organization representing consumers;
(3) Any individual residing within the geographic area served or to be served by the applicant;
(4) Any individual who regularly uses the health care facilities within that geographic area;
(5) The health care facilities which provide services similar to the services of the facility under review and which will be significantly affected by the proposed project;
(6) The health care facilities which, prior to receipt by the state agency of the proposal being reviewed, have formally indicated an intention to provide similar services in the future;
(7) Third-party payors who reimburse health care facilities similar to those proposed for services;
(8) Any agency which establishes rates for health care facilities similar to those proposed; or
(9) Organizations representing health care providers.
(b) "Ambulatory health care facility center" means a facility which is free-standing and not physically attached to a health care facility and which provides health care to noninstitutionalized and nonhomebound persons on an outpatient basis. This definition does not include the private office practice of any one or more health professionals licensed to practice in this state pursuant to the provisions of chapter thirty of this code: Provided, That such exemption from review of private office practice shall not be construed to include such practices where major medical equipment otherwise subject to review under the provisions of this article is acquired, offered or developed: Provided, however, That such exemption from review of private office practice shall not be construed to include certain health services otherwise subject to review under the provisions of subdivision (1), subsection (a), section four of this article.a free-standing facility, staffed by one or more health care professionals, which provides services on an outpatient basis and:
(1) (A) Contains medical equipment as defined in subsection w of this section with a total value exceeding the level of the expenditure minimum, or acquires medical equipment in any two year period with a total value in excess of three hundred thousand dollars, and;
(B) Falls within one of the following categories of ambulatory care centers:
(i) Urgent care centers;
(ii) Diagnostic centers; or
(iii) Ambulatory surgery centers; and
(C) Is not a community based primary care center; or
(2) Involves the establishment of a new institutional health service and is an outpatient behavioral health facility.
(c) "Ambulatory surgical facility" means a facility which is free-standing and not physically attached to a health care facility and which provides surgical treatment to patients not requiring hospitalization. This definition does not include the private office practice of any one or more health professionals licensed to practice surgery in this state pursuant to the provisions of chapter thirty of this code: Provided, That such exemption from review of private office practice shall not be construed to include such practices where major medical equipment otherwise subject to review under the provisions of this article is acquired, offered or developed: Provided, however, That such exemption from review of private office practice shall not be construed to include certain health services otherwise subject to review under the provisions of subdivision (1), subsection (a), section four of this article. "Ambulatory surgery center" means a facility for the provision of surgical services that require anesthesia or a period of post-operative observation, or both, to patients whose admission for an overnight stay is not anticipated, which facility does not or will not provide beds for overnight confinement and which facility is or will be;
(1) Totally independent and separate, having at least four operating suites;
(2) Physically located within a hospital complex, but having a separate and independent financial and administrative status and having at least four operating suites;
(3) Financially and administratively linked to a hospital and having at least four operating suites; or
(4) Part of a private office practice of a health care professional, other than an oral surgeon or a podiatrist, if there are two or more operating room suites, if general, epidural, or spinal anesthesia is provided, and if the physician charges an additional fee for the use of the facility.
(d) "Applicant" means: (1) The governing body or the person proposing a new institutional health service who is, or will be, the health care facility licensee wherein the new institutional health service is proposed to be located, and (2) in the case of a proposed new institutional health service not to be located in a licensed health care facility, the governing body or the person proposing to provide such new institutional health service. Incorporators or promoters who will not constitute the governing body or persons responsible for the new institutional health service may not be an applicant.
(e) "Bed capacity" means the number of beds for which a license is issued to a health care facility, or, if a facility is unlicensed, the number of adult and pediatric beds permanently staffed and maintained for immediate use by inpatients in patient rooms or wards.
(f) "Capital expenditure" means an expenditure:
(1) Made by or on behalf of a health care facility; and
(2) (A) Which (i) under generally accepted accounting principles is not properly chargeable as an expense of operation and maintenance, or (ii) is made to obtain either by lease or comparable arrangement any facility or part thereof or any equipment for a facility or part; and (B) which (i) exceeds the expenditure minimum, or (ii) is a substantial change to the bed capacity of the facility with respect to which the expenditure is made, or (iii) is a substantial change to the services of such facility. For purposes of subparagraph (i), paragraph (B), subdivision (2) of this definition, the cost of any studies, surveys, designs, plans, working drawings, specifications, and other activities, including staff effort and consulting and other services, essential to the acquisition, improvement, expansion, or replacement of any plant or equipment with respect to which an expenditure described in paragraph (B), subdivision (2) of this definition is made shall be included in determining if such expenditure exceeds the expenditure minimum. Donations of equipment or facilities to a health care facility which if acquired directly by such facility would be subject to review shall be considered capital expenditures, and a transfer of equipment or facilities for less than fair market value shall be considered a capital expenditure for purposes of such subdivisions if a transfer of the equipment or facilities at fair market value would be subject to review. A series of expenditures, each less than the expenditure minimum, which when taken together are in excess of the expenditure minimum, may be determined by the state agency to be a single capital expenditure subject to review. In making its determination, the state agency shall consider: Whether the expenditures are for components of a system which is required to accomplish a single purpose; whether the expenditures are to be made over a two-year period and are directed towards the accomplishment of a single goal within the health care facility's long-range plan; or whether the expenditures are to be made within a two-year period within a single department such that they will constitute a significant modernization of the department.
(g) "Capital expenditure allocation" means the maximum aggregate principal amount of capital expenditure allocated by the health care authority to institutional health services or a particular class of health services during the state's fiscal year.
(h) "Community-based primary care center" means a primary care facility operated by a tax exempt, nonprofit organization with a community board that provides or will provide primary care services to people without regard to ability to pay and offers or will offer health education and preventive services to people in its service area.
(i) "Community board" means a board of directors of a primary care center that has sufficient community representation to enable the board to qualify as a board of a federally qualified health care center.
(j) "Diagnostic center" means a facility that offers routine diagnostic outpatient testing and procedures, including, but not limited to, laboratory, radiography, ultrasound, testing for general physical examinations, drug screening, nuclear medicine, imaging, or other procedures that can be reasonably performed in an outpatient setting.
(l) (k) "Expenditure minimum" means seven hundred fifty thousand dollars per fiscal year: Provided, That the private office practice of one or more health care practitioners is not a diagnostic center unless more than fifty percent of the gross revenue received by such practice for patient care services results from diagnostic outpatient testing and procedures other than general physical examination.
(h) (l)"Health," used as a term, includes physical and mental health.
(i) (m) "Health care facility" means hospitals, skilled nursing facilities, kidney disease treatment centers, including free-standing hemodialysis units, intermediate care facilities, ambulatory health care facilities centers, ambulatory surgical facilities, home health agencies, rehabilitation facilities and health maintenance organizations, community mental health and mental retardation facilities, whether under public or private ownership, or as a profit or nonprofit organization and whether or not licensed or required to be licensed in whole or in part by the state. For purposes of this definition, "community mental health and mental retardation facility" means a private facility which provides such comprehensive services and continuity of care as emergency, outpatient, partial hospitalization, inpatient and consultation and education for individuals with mental illness, mental retardation or drug or alcohol addiction means a category of facility which includes but is not limited to hospitals; nursing facilities; kidney disease treatment centers, including free standing hemodialysis units; ambulatory care centers, including ambulatory surgery centers, community-based primary care centers, diagnostic centers, urgent care centers and outpatient behavioral health facilities; and rehabilitation facilities. Health care facilities owned, operated, managed or controlled by health maintenance organizations and preferred provider organizations are specifically included in this definition.
(n) "Health care authority" or "authority" means the West Virginia health care authority created in section five, article one, chapter sixteen-a of this code.
(j) (o) "Health care provider" means a any person, partnership, corporation, facility or institution, including, but not limited to, one licensed or, certified or authorized by law to provide professional health care service services in this state to an individual during that individual's medical health care, treatment or confinement.
(k) (p) "Health maintenance organization" means a public or private organization, organized under the laws of this state, which:
(1) Is a qualified health maintenance organization under Section 1310(d) of the Public Health Service Act, as amended, Title 42 United States Code Section 300e-9(d); or
(2) (A) Provides or otherwise makes available to enrolled participants health care services, including substantially the following basic health care services: Usual physician services, hospitalization, laboratory, X ray, emergency and preventive services and out-of-area coverage; and
(B) Is compensated except for copayments for the provision of the basic health care services listed in paragraph (A), subdivision (2), subsection (k) of this definition to enrolled participants on a predetermined periodic rate basis without regard to the date the health care services are provided and which is fixed without regard to the frequency, extent or kind of health service actually provided; and
(C) Provides physicians' services primarily (i) directly through physicians who are either employees or partners of such organization, or (ii) through arrangements with individual physicians or one or more groups of physicians organized on a group practice or individual practice basis. an organization which provides its enrollees with a package of health services, either directly in its own clinical setting or through contractual arrangements, for a fee for service or 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.
(l) (q) "Health services" means clinically related preventive, diagnostic, treatment or rehabilitative services, including alcohol, drug abuse and mental health services.
(m) (r) "Home health agency" is means an organization primarily engaged in providing directly, or through contract arrangements, professional skilled nursing services, and at least two additional services, including, but not limited to, homemaker or home health aide services, and other therapeutic and related services, including, but not limited to, physical, speech and or occupational therapy and, nutritional services and medical social services, provided to persons individuals and families in their place places of residence on a part-time or intermittent basis for the purpose or purposes of preventing disease and promoting, maintaining or restoring health or minimizing the effects of illness or disability.
(x) (s) "Hospice" means a coordinated program providing a continuum of home and inpatient care, available twenty-four hours a day, seven days a week, for terminally ill patients and their families and significant others.
(n) (t) "Hospital" means an institution which is primarily engaged in providing to inpatients, by or under the supervision of physicians, diagnostic and therapeutic services for medical diagnosis, treatment, and care of persons who are injured, disabled or sick persons, or rehabilitation services for the rehabilitation of persons who are injured, disabled or sick persons. This term also includes psychiatric and tuberculosis hospitals.
(o) "Intermediate care facility" means an institution which provides, on a regular basis, health-related care and services to individuals who do not require the degree of care and treatment which a hospital or skilled nursing facility is designed to provide, but who, because of their mental or physical condition, require health-related care and services above the level of room and board.
 (z) (u) "Long range plan" means a document formally adopted by the legally constituted governing body of an existing health care facility or by a person proposing a new institutional health service, which document is intended to provide strategic guidance for the development of the facility or service over the ensuing three to ten year period. Each long-range plan shall consist of the information required by the state agency in regulations rules adopted pursuant to section eight of this article.
(q) (v) "Major medical equipment" means a single unit of medical equipment or a single system of components with related functions which is used for the provision of medical and other health services and which costs in excess of three hundred thousand dollars, except that such term does not include medical equipment acquired by or on behalf of a clinical laboratory to provide clinical laboratory services if the clinical laboratory is independent of a physician's office and a hospital and it has been determined under Title XVIII of the Social Security Act to meet the requirements of paragraphs ten and eleven of Section 1861(s) of such act, Title 42 United States Code Sections 1395x (10) and (11) certified under the requirements of Title 42 United States Code Section 263a. In determining whether medical equipment costs more than three hundred thousand dollars, the cost of studies, surveys, designs, plans, working drawings, specifications, and other activities essential to the acquisition of such equipment shall be included. If the equipment is acquired for less than fair market value, the term "cost" includes the fair market value. (w) "Medical equipment" means fixed or movable equipment which is directly used in the diagnosis or treatment of a patient. Examples of medical equipment include but are not limited to x-ray imaging equipment, blood analysis, operating room tables, physical therapy apparatus, radiation dosage computers and ultrasound equipment.
(r) (x) "Medically underserved population" means the population of a geographic area designated by the state agency health care authority as an area with a shortage of personal health services or a population having a shortage of such services, after taking into account any unusual local conditions which are may create a barrier to accessibility or availability of such services. Such designation shall be in regulations rules adopted by the state agency pursuant to section eight of this article in conformity with policies and determinations of the health care authority, and the population so designated may include the state's medically underserved population designated by the Federal United States Secretary of Health and Human Services under Section 330(b)(3) of the Public Health Service Act, as amended, Title 42 United States Code Section 254(b)(3) 254c(b)(3)
(y) "Medical-physical rehabilitation" means the medical management of a physical disability using all methods of diagnosis and treatment with other procedures and services, including, but not limited to, orthopedics, neurology, neurosurgery, internal medicine, rheumatology, psychiatry, physical, occupational, recreational and speech therapies, social, psychological and vocational evaluation and counseling, prosthetics and orthotics, dental prosthetics, physiatrics, and nursing, to bring a person with a disability and identified as having potential for improvement to his or her maximum attainable functional level.
(s) (z) "New institutional health service" means such service as described in section three of this article.
(aa) "Notice of substantial compliance" means the notice required to be issued and maintained pursuant to section eleven of this article.
(bb) "Nursing facility" means an institution or a distinct part of an institution which provides skilled nursing care or intermediate nursing care, or both, and related services to persons who do not require the degree of care and treatment which a hospital is designed to provide but who, because of their mental or physical conditions, require health care and related services on a regular inpatient basis.
(t) (cc) "Offer", when used in connection with health services, means that the health care facility or health maintenance organization holds itself out as capable of providing, or as having the means for the provision of, specified health services.
(dd) "Outpatient behavioral health facility" means a facility for the provision of specialized health care services on an outpatient basis by licensed health professionals concerned with patients with behavioral disorders, mental deficiencies or brain tissue impairments.
(u) (ee) "Person" means an individual, trust, estate, partnership, committee, corporation, association and other organizations such as joint-stock companies and insurance companies, a state or a political subdivision or instrumentality thereof or any legal entity recognized by the state.
(v) (ff) "Physician" means a doctor of medicine or osteopathy legally authorized to practice by the state.
(gg) "Preferred provider organization" means an organization which provides or arranges a preferred health care provider network for the provision of health care services to certain persons. The provider may be preferred on the basis of the health service(s) it provides and/or the fees it charges for health care services, and this definition includes exclusive provider organizations.
(w) (hh) "Proposed new institutional health service" means such service as described in section three of this article.
(x) (ii) "Psychiatric hospital" means an institution which primarily provides to inpatients, by or under the supervision of a physician, specialized services for the diagnosis, treatment and rehabilitation of mentally ill and emotionally disturbed persons with mental illness or emotional disturbances.
(y) (jj) "Rehabilitation facility" means an inpatient facility which is operated for the primary purpose of assisting in the providing medical-physical rehabilitation of disabled to persons with disabilities. through an integrated program of medical and other services which are provided under competent professional supervision.
(z) (kk) "Review agency" means an agency of the state, designated by the governor as the agency for the review of state agency decisions.
(aa) "Skilled nursing facility" means an institution or a distinct part of an institution which is primarily engaged in providing to inpatients skilled nursing care and related services for patients who require medical or nursing care, or rehabilitation services for the rehabilitation of injured, disabled or sick persons.
(bb) (ll) "State agency" means the health care cost review authority created, established, and continued pursuant to article twenty-nine-b of this chapter.
(cc) (mm) "State health plan" means the document approved by the governor after preparation by the former statewide health coordinating council, or that document as approved by the governor after submission by the health care planning council or its successor agency health care planning commission or, after the first day of September, one thousand nine hundred ninety-four, the health care authority.
(dd) "Health care planning council" means the body established by section five-a of this article to participate in the preparation and amendment of the state health plan and to advise the state agency.
(ee) (nn) "Substantial change to the bed capacity" of a health care facility means any change, with which a capital expenditure is associated, that increases or decreases the bed capacity, or relocates beds from one physical facility or site to another, but does not include a change by which a health care facility reassigns existing beds as swing beds between acute care and long-term care categories: Provided, That a decrease in bed capacity in response to federal rural health initiatives shall be excluded from this definition.
(ff) (oo) "Substantial change to the health services" of a health care facility means the addition of a health service which is offered by or on behalf of the health care facility and which was not offered by or on behalf of the facility within the twelve-month period before the month in which the service is first offered, or the termination of a health service which was offered by or on behalf of the facility, but does not include the providing of hospice care, ambulance service, projects receiving funding under subdivision (d), section two, article two-h, chapter sixteen of this code, wellness centers or programs, adult day care, or respite care by acute care facilities if allowable under the expenditure minimum, all as further defined by rules adopted pursuant to section eight of this article.
(gg)(pp) "To develop", when used in connection with health services, means to undertake those activities which upon their completion will result in the offer of a new institutional health service or the incurring of a financial obligation, in relation to the offering of such a service.
(qq) "Uniform health benefits package" means the standard package of medically appropriate health services established by the health care authority under section eleven, article one, chapter sixteen-a of this code.
(rr) "Urgent care center" means a free standing medical care center, which may be proprietary or nonprofit, which provides or will provide services such as medical care for minor injuries or symptoms, drug screening and dispensing, primary care, pediatrics, orthopedics, physical or occupational therapy, gynecology, ear-nose-and-throat services, minor surgery, dermatology, cancer screening, diet control, psychological and allergy testing, simple diagnostic procedures and radiology, and which is or will be open for more than sixty hours per week.
(ss) "Value" means the fair market value at the time of evaluation, without regard to who owns the item or items being valued.
 § 16 - 2D - 3. Certificate of need.
Except as provided in section four of this article, any new institutional health service may not be acquired, offered or developed within this state except upon application for and receipt of a certificate of need as provided by this article. Whenever a new institutional health service for which a certificate of need is required by this article is proposed for a health care facility for which, pursuant to section four of this article, no certificate of need is or was required, a certificate of need shall be issued before the new institutional health service is offered or developed. No person may knowingly charge or bill for any health services associated with any new institutional health service that is knowingly acquired, offered or developed in violation of this article, and any bill made in violation of this sentence is legally unenforceable. For purposes of this article, a proposed "new institutional health service" includes:
(a) The construction, development, acquisition or other establishment of a new health care facility or health maintenance organization;
(b) The partial or total closure of a health care facility or health maintenance organization with which a capital expenditure is associated;
(c) Any obligation for a capital expenditure incurred by or on behalf of a health care facility, except as exempted in section four of this article, or health maintenance organization in excess of the expenditure minimum or any obligation for a capital expenditure incurred by any person to acquire a health care facility. An obligation for a capital expenditure is considered to be incurred by or on behalf of a health care facility:
(1) When a contract, enforceable under state law, is entered into by or on behalf of the health care facility for the construction, acquisition, lease or financing of a capital asset;
(2) When the governing board of the health care facility takes formal action to commit its own funds for a construction project undertaken by the health care facility as its own contractor; or
(3) In the case of donated property, on the date on which the gift is completed under state law; or
(4) Such other criteria specified in the state health plan or by the health care authority.
(d) A substantial change to the bed capacity of a health care facility with which a capital expenditure is associated;
(e) (1) The addition of health services which are offered by or on behalf of a health care facility or health maintenance organization and which were not offered on a regular basis by or on behalf of the health care facility or health maintenance organization within the twelve-month period prior to the time the services would be offered; and
(2) The addition of ventilator services for any nursing facility bed by any health care facility or health maintenance organization;
(f) The deletion of one or more health services, previously offered on a regular basis by or on behalf of a health care facility or, health maintenance organization which deletion is associated with a capital expenditure;
(g) A substantial change to the bed capacity or health services offered by or on behalf of a health care facility, whether or not the change is associated with a proposed capital expenditure, if the change is associated with a previous capital expenditure for which a certificate of need was issued and if the change will occur within two years after the date the activity which was associated with the previously approved capital expenditure was undertaken;
(h) The acquisition of major medical equipment;
(i) A substantial change in an approved new institutional health service for which a certificate of need is in effect. For purposes of this subsection, "substantial change" shall be defined by the state agency in regulations adopted pursuant to section eight of this article.
(j) For purposes of subsection (e) of this section, the state agency shall adopt rules pursuant to section eight of this article specifying the additional health services which are subject to certificate of need review. The health services specified shall not include the providing of hospice care, ambulance service, projects receiving funding under subdivision (d), section two, article two-h, chapter sixteen of this code, wellness centers or programs, adult day care, home health services or respite care under the expenditure minimum.
 § 16 - 2D - 4. Exemptions from certificate of need program.
(a) Except as provided in subdivision (h), section three of this article, nothing in this article or the rules and regulations adopted pursuant to the provisions of this article may be construed to authorize the licensure, supervision, regulation or control in any manner of the following:
(1) Private office practice of any one or more health professionals licensed to practice in this state pursuant to the provisions of chapter thirty of this code: Provided, That such exemption from review of private office practice shall not be construed to include such practices where major medical equipment otherwise subject to review under the provisions of this article is acquired, offered or developed or private office practices that constitute the operation of an ambulatory care center: Provided, however, That such exemption from review of private office practice shall not be construed to include the acquisition, offering or development of one or more health services, including ambulatory surgical facilities or centers, lithotripsy, magnetic resonance imaging and radiation therapy by one or more health professionals. The state agency shall adopt rules pursuant to section eight of this article which specify the health services acquired, offered or developed by health professionals which are subject to certificate of need review
 Provided, however, That the sale of the private office practice of any one or more health professionals to one or more other health professionals of the same or similar type shall not be subject to the provisions of section three, article two-d, chapter sixteen of this code unless such sale creates a "substantial change to the health services" as that term is defined in section two of this article;
(2) Shared service mobile unit in service prior to the effective date of this article: Provided, That such exemption shall not be available to a purchaser who purchases such shared mobile unit after the effective date of this article."
(2) (3) Dispensaries and first-aid stations located within business or industrial establishments maintained solely for the use of employees: Provided, That such facility does not contain inpatient or resident beds for patients or employees who generally remain in the facility for more than twenty-four hours;
(3) (4) Establishments, such as motels, hotels and boardinghouses, which provide medical, nursing personnel and health related services;
(4) (5) The remedial care or treatment of residents or patients in any home or institution conducted only for those who rely solely upon treatment by prayer or spiritual means in accordance with the creed or tenets of any recognized church or religious denomination;
(5) The creation of new primary care services located in communities that are underserved with respect to primary care services: Provided, That to qualify for this exemption, an applicant must be a community-based nonprofit organization with a community board that provides or will provide primary care services to people without regard to ability to pay: Provided, however, That although the exemption from certificate of need review of new primary care services provided by this subdivision shall apply to the expenditure minimum, it shall not include apply to the acquisition, offering or development of major medical equipment otherwise subject to review under the provisions of this article or to include the acquisition, offering or development of CT scanners, ambulatory surgical facilities, lithotripsy, magnetic resonance imaging or radiation therapy. The office of community and rural health services shall define which services constitute primary care services for purposes of this subdivision, and shall, to prevent duplication of primary care services, determine whether a community is underserved with respect to certain primary care services within the meaning of this subdivision. Any Unless otherwise provided for by any provision of this section, any organization planning to qualify for an exemption pursuant to this subdivision shall submit to the state agency a letter of intent describing the proposed new services and area of service; and
(6) (7) The creation of birthing centers by nonprofit primary care centers that have a community board and provide primary care services to people in their community without regard to ability to pay, or by nonprofit hospitals with less than one hundred licensed acute care beds: Provided, That to qualify for this exemption, an applicant must be located in an area that is underserved with respect to low-risk obstetrical services: Provided, however, That if a primary care center attempting to qualify for this exemption is located in the same county as a hospital that is also eligible for this exemption, or if a hospital attempting to qualify for this exemption is located in the same county as a primary care center that is also eligible for this exemption, then at least one primary care center and at least one hospital from said county shall be required to collaborate for the provision of services at a birthing center in order to qualify for this exemption: Provided further, That for purposes of this subsection, a "birthing center" is a short-stay ambulatory health care facility designed for low-risk births following normal uncomplicated pregnancy. Any primary care center or hospital planning to qualify for an exemption pursuant to this subdivision shall submit to the state agency a letter of intent describing the proposed birthing center and area of service.
(b) (1) A certificate of need is not required for the offering of an inpatient institutional health service or the acquisition of major medical equipment for the provision of an inpatient institutional health service or the obligation of a capital expenditure for the provisions of an inpatient institutional health service, if with respect to such offering, acquisition or obligation, the state agency has, upon application under subdivision (2) of this subsection, granted an exemption to:
(A) A health maintenance organization or a combination of health maintenance organizations if: (i) The organization or combination of organizations has, in the service area of the organization or the service areas of the organizations in the combination, an enrollment of at least fifty thousand individuals; (ii) the facility in which the service will be provided is or will be geographically located so that the service will be reasonably accessible to such enrolled individuals; and (iii) at least seventy-five percent of the patients who can reasonably be expected to receive the institutional health service will be individuals enrolled with such organization or organizations in the combination;
(B) A health care facility if: (i) The facility primarily provides or will provide inpatient health services; (ii) the facility is or will be controlled, directly or indirectly, by a health maintenance organization or a combination of health maintenance organizations which has, in the service area of the organization or service areas of the organizations in the combination, an enrollment of at least fifty thousand individuals; (iii) the facility is or will be geographically located so that the service will be reasonably accessible to such enrolled individuals; and (iv) at least seventy-five percent of the patients who can reasonably be expected to receive the institutional health service will be individuals enrolled with such organization or organizations in the combination; or
(C) A health care facility, or portion thereof, if: (i) The facility is or will be leased by a health maintenance organization or combination of health maintenance organizations which has, in the service area of the organization or the service areas of the organizations in the combination, an enrollment of at least fifty thousand individuals and on the date the application is submitted under subdivision (2) of this subsection, at least fifteen years remain in the term of the lease; (ii) the facility is or will be geographically located so that the service will be reasonably accessible to such enrolled individuals; and (iii) at least seventy-five percent of the patients who can reasonably be expected to receive the new institutional health service will be individuals enrolled with such organization.
(2) (A) A health maintenance organization, combination of health maintenance organizations or other health care facility is not exempt under subdivision (1) of this subsection from obtaining a certificate of need unless:
(i) It has submitted, at such time and in such form and manner as the state agency shall prescribe, an application for such exemption to the state agency;
(ii) The application contains such information respecting the organization, combination or facility and the proposed offering, acquisition or obligation as the state agency may require to determine if the organization or combination meets the requirements of subdivision (1) of this subsection or the facility meets or will meet such requirements; and
(iii) The state agency approves such application.
(B) The state agency shall approve an application submitted under paragraph (A) of this subdivision, if it determines that the applicable requirements of subdivision (1) of this subsection are met or will be met on the date the proposed activity for which an exemption was requested will be undertaken.
(3) A health care facility, or any part thereof, or medical equipment with respect to which an exemption was granted under subdivision (1) of this subsection, may not be sold or leased and a controlling interest in such facility or equipment or in a lease of such facility or equipment may not be acquired and a health care facility described in paragraph (C) of said subdivision, which was granted an exemption under said subdivision, may not be used by any person other than the lessee described in paragraph (C) of said subdivision, unless:
(A) The state agency issues a certificate of need approving the sale, lease, acquisition or use; or
(B) The state agency determines, upon application, that the entity to which the facility or equipment is proposed to be sold or leased, which intends to acquire the controlling interest in or to use the facility is:
(i) A health maintenance organization or a combination of health maintenance organizations which meets the enrollment requirements of subparagraph (i), paragraph (A), subdivision (1) of this subsection, and with respect to such facility or equipment, the entity meets the accessibility and patient enrollment requirements of subparagraphs (ii) and (iii) of said paragraph; or
(ii) A health care facility which meets the inpatient, enrollment and accessibility requirements of subparagraphs (i), (ii) and (iii), paragraph (B), subdivision (1) of this subsection and with respect to its patients meets the enrollment requirements of subparagraph (iv) of said paragraph (B).
(4) In the case of a health maintenance organization or an ambulatory care facility or health care facility which ambulatory or health care facility is controlled, directly or indirectly, by a health maintenance organization or a combination of health maintenance organizations, the certificate of need requirements apply only to the offering of inpatient institutional health services, the acquisition of major medical equipment, and the obligation of capital expenditures for the offering of inpatient institutional health services and then only to the extent that such offering, acquisition or obligation is not exempt under subdivision (1) of this subsection.
(5) The state agency shall establish the period within which approval or disapproval by the state agency of applications for exemptions under subdivision (1) of this subsection shall be made.
(c) (b) (1) A health care facility is not required to obtain a certificate of need for the acquisition of major medical equipment to be used solely for research, the addition of health services to be offered solely for research, or the obligation of a capital expenditure to be made solely for research if such research has been approved by the health care authority in accordance with rules adopted by it. The health care authority shall provide the state agency with a written copy of such approval at the same time it is provided to the health care provider: Provided, That nothing herein is intended to interfere with research projects or to require prior approval by the authority for all such projects. Rules shall be promulgated by the state agency to assure that research is exempt from certificate of need approval where such prior approval would jeopardize acquisition of research grants. if the health care facility provides the notice required in subdivision (2) of this subsection, and the state agency does not find, within sixty days after it receives such notice, that the acquisition, offering or obligation will, or will have the effect to:
(A) Affect the charges of the facility for the provision of medical or other patient care services other than the services which are included in the research;
(B) Result in a substantial change to the bed capacity of the facility; or
(C) Result in a substantial change to the health services of the facility.
(2) Before a health care facility acquires major medical equipment to be used solely for research, offers a health service solely for research or obligates a capital expenditure solely for research, such health care facility shall notify in writing the state agency of such facility's intent and the use to be made of such medical equipment, health service or capital expenditure.
(3) If major medical equipment is acquired, a health service is offered or a capital expenditure is obligated and a certificate of need is not required for such acquisition, offering or obligation as provided in subdivision (1) of this subsection, such equipment or service or equipment or facilities acquired through the obligation of such capital expenditure may not be used in such a manner as to have the effect or to make a change described in paragraphs (A), (B) and (C) of said subdivision unless the state agency issues a certificate of need approving such use.
(4) For purposes of this subsection, the term "solely for research" includes patient care provided on an occasional and irregular basis and not as part of a research program.
(d) (c) (1) The state agency may adopt regulations rules pursuant to section eight of this article to specify the circumstances under which a certificate of need may not be required for the obligation of a capital expenditure to acquire, either by purchase or under lease or comparable arrangement, an existing health care facility: Provided, That a certificate of need shall be required for the obligation of a capital expenditure to acquire, either by purchase or under lease or comparable arrangement, an existing health care facility if:
(A) The notice required by subdivision (2) of this subsection is not filed in accordance with that subdivision with respect to such acquisition; or
(B) The state agency finds, within thirty days after the date it receives a notice in accordance with subdivision (2) of this subsection, with respect to such acquisition, that the services or bed capacity of the facility will be changed by reason of said acquisition.
(2) Before any person enters into a contractual arrangement to acquire an existing health care facility, such person shall notify the state agency of his or her intent to acquire the facility and of the services to be offered in the facility and its bed capacity. Such notice shall be made in writing and shall be made at least thirty days before contractual arrangements are entered into to acquire the facility with respect to which the notice is given. The notice shall contain all information the state agency requires in accordance with subsections (e) and (s), section seven of this article.
(e) (d) The state agency shall adopt regulations rules pursuant to section eight of this article, wherein criteria are established to exempt from review the addition of certain health services, not associated with a capital expenditure, that are projected to entail annual operating costs of less than the expenditure minimum for annual operating costs, as defined by said rules. For purposes of this subsection, "expenditure minimum for annual operating costs" means three hundred thousand dollars for the first twelve months following the effective date of this section and for each twelve-month period thereafter, the state agency may, by regulations adopted pursuant to section eight of this article, adjust the expenditure minimum for annual operating costs to reflect the impact of inflation.
(f) The state agency shall adopt rules within ninety days of the effective date of the amendment of this section in the year one thousand nine hundred ninety pursuant to section eight of this article to specify the circumstances under which and the procedures by which a certificate of need may not be required for shared services between two or more acute care facilities providing services made available through existing technology that can reasonably be mobile. The state agency shall specify the types of items in the regulations and under what circumstances mobile MRI and mobile lithotripsy may be so exempted from review. In no case, however, will mobile cardiac catheterization be exempted from certificate of need review. In addition, if the shared services mobile unit proves less cost effective than a fixed unit, the acute care facility will not be exempted from certificate of need review.
On a yearly basis, the state agency shall review existing technologies to determine if other shared services should be included under this exemption.
(g) (e) This subsection applies only to hospitals designated as rural primary care hospitals, by the West Virginia office of rural health policy in conformance with requirements of the health care financing administration of the federal department of health and human services under Section 1920 of Public Law 101-239, Section 6000(g) of the federal Omnibus Budget Reconciliation Act of 1989 1395(i) - 4(i)(2) of Title 42.
A hospital, designated as a rural primary care hospital, in accordance with final rules issued by the health care financing administration, shall undergo a reduction in its number of licensed acute care beds as determined, by the office of rural health policy.
The office of rural health policy, shall notify the health care cost review authority state agency of such designation including the number of staffed and operated beds immediately prior to designation and the number of acute care beds certified by the health care financing administration.
A rural primary care hospital may reject this designation any time within twenty-four calendar months, beginning from the date of designation by the office of rural health policy. If a hospital chooses to reject this designation, it may do so upon written notification to the office of rural health policy and the health care cost review authority state agency. If such designation is rejected by a rural primary care hospital, license restoration, not to exceed the number of acute care beds staffed and operated by the hospital immediately prior to receiving designation as a rural primary care hospital, shall be exempt from the certificate of need program review.
Within twenty-five months from designating rural primary care hospitals, the office shall notify the health care cost review authority state agency of the status of the designated hospitals including the number of licensed beds.
The state agency shall promulgate rules within ninety days of the effective date of this amendment in order necessary to carry out the purpose of this subsection.
 § 16 - 2D - 5. Powers and duties of state agency.
(a) The state agency is hereby empowered to administer the certificate of need program as provided by this article.
(b) The state agency shall cooperate with the health care planning commission authority in developing rules and regulations and enforcing standards contained in the state health plan for the certificate of need program to the extent appropriate for the achievement of efficiency in their reviews and consistency in criteria for such reviews.
(c) The state agency may seek advice and assistance of other persons, organizations, and other state agencies in the performance of the state agency's responsibilities under this article.
(d) For health services for which competition appropriately allocates supply consistent with the state health plan, the state agency shall, in the performance of its functions under this article, give priority, where appropriate to advance the purposes of quality assurance, cost effectiveness and access, to actions which would strengthen the effect of competition on the supply of such services.
(e) For Notwithstanding the provisions of subsection (d) of this section, the Legislature hereby finds that the benefits to be derived from the integration and coordination of, and the cooperation and collaboration among, health care providers and the allocation of health care services among health care providers, including among those parties who might otherwise compete against one another, often provides more benefits than the competition that might otherwise exist. Consequently, for health services for which competition does not or will not appropriately allocate supply consistent with the state health plan, or which does not advance the purposes of quality assurance, cost effectiveness and access as well as integration, coordination, cooperation and collaboration, the state agency shall, in the exercise of its functions under this article, make specific findings with respect to the reasons therefore and take actions, where appropriate to advance the purposes of quality assurance, cost effectiveness and access and the other purposes of this article, to allocate the supply of or approve the integration and coordination of such services and the cooperation and collaboration among such health care providers in the integration and coordination of such services .
(f) Notwithstanding the provisions of section seven of this article, the state agency may charge a fee for the filing of any application, the filing of any notice in lieu of an application, the filing of any exemption determination request, or the filing of any request for a declaratory ruling. The fees charged may vary according to the type of matter involved, the type of health service or facility involved, or the amount of capital expenditure involved. The state agency shall implement this subsection by filing procedural rules pursuant to chapter twenty-nine-a of this code. The fees charged shall be deposited into a an appropriated special fund known as the certificate of need program fund to be expended for the purposes of this article.
(g) No hospital, nursing home or other health care facility shall add any intermediate care or skilled nursing beds to its current licensed bed complement. This prohibition also applies to the conversion of acute care or other types of beds to intermediate care or skilled nursing beds: Provided, That hospitals eligible under the provisions of section four-a and subsection (i),of this section five of this article may convert acute care beds to skilled nursing beds in accordance with the provisions of these sections that section, upon approval by the state agency. Furthermore, no certificate of need shall be granted for the construction or addition of any intermediate care or skilled nursing beds except in the case of facilities designed to replace existing beds in unsafe existing facilities. A health care facility in receipt of a certificate of need for the construction or addition of intermediate care or skilled nursing beds which was approved prior to the effective date of this section must incur an obligation for a capital expenditure within twelve months of the date of issuance of the certificate of need. No extensions shall be granted beyond the twelve-month period: Provided, however, That a hospital designated or provisionally designated as a rural primary care hospital may convert not to exceed sixty acute care beds, licensed immediately prior to designation as a rural primary care hospital, to a distinct part nursing facility including skilled nursing beds and intermediate care beds, on a one-for-one basis, if said rural primary care hospital also meets the following criteria: (1) The hospital has previously constructed a unit that can be used as a distinct part nursing facility; and (2) the hospital has an affiliation agreement with a college or university to provide clinical training to mid-level practitioners: Provided further, That said rural primary care hospital applies for conversion on or before the thirtieth day of September, one thousand nine hundred ninety-two.
(h) No additional intermediate care facility for the mentally retarded (ICF/MR) beds shall be granted a certificate of need. except that prohibition does not apply to ICF/MR beds approved under the Kanawha County circuit court order of the third day of August, one thousand nine hundred eighty-nine, civil action number MISC-81-585 issued in the case of E. H. v. Matin, 168 W.V. 248, 284 S.E.2d 232 (1981).
(i) Notwithstanding the provisions of subsection (g), of this section five of this article and, further notwithstanding the provisions of subsection (d), section three of this article, an existing acute care hospital may apply to the health care cost review authority state agency for a certificate of need to convert acute care beds to skilled nursing beds: Provided, That the proposed skilled nursing beds are medicare certified only: for the purposes of this subsection, "skilled nursing beds" means only those nursing beds for which the hospital receives reimbursement for skilled nursing care pursuant to Title XVIII of the Social Security Act; Provided, however, That any hospital which converts acute care beds to medicare certified only skilled nursing beds is prohibited from billing for any medicaid reimbursement for any beds so converted. In converting beds, the hospital must convert a minimum of one acute care bed into one medicare certified only skilled nursing bed. The health care cost review authority state agency may require a hospital to convert up to and including three acute care beds for each medicare certified only skilled nursing bed. The health care cost review authority state agency shall adopt rules to implement this subsection which require that:
(1) All acute care beds converted shall be permanently deleted from the hospital's acute care bed complement and the hospital may not thereafter add, by conversion or otherwise, acute care beds to its bed complement without satisfying the requirements of subsection (d), section three of this article for which purposes such an addition, whether by conversion or otherwise, shall be considered a substantial change to the bed capacity of the hospital notwithstanding the definition of that term found in subsection (ee) (nn) section two of this article.
(2) The hospital shall meet all federal and state licensing certification and operational requirements applicable to nursing homes including a requirement that all skilled care nursing beds created under this subsection shall be located in distinct-part, long-term care units.
(3) The hospital must demonstrate a need for the project.
(4) The hospital must use existing space for the medicare certified only skilled nursing beds. Under no circumstances shall the hospital construct, lease or acquire additional space for purposes of this section.
(5) The hospital must notify the acute care patient, prior to discharge, of facilities with skilled nursing beds which are located in or near the patient's county of residence.
Nothing in this subsection shall negatively affect the rights of inspection and certification which are otherwise required by federal law or regulations or by this code of duly adopted regulations rules of an authorized state entity.
(j) Notwithstanding the provisions of subsection (g), of this section five of this article, a retirement life care center with no skilled nursing beds may apply to the health care cost review authority state agency for a certificate of need for up to sixty skilled nursing beds: Provided, That, provided the proposed skilled beds are medicare certified only. for the purposes of this subsection, "skilled nursing beds" means only those nursing beds for which the hospital receives reimbursement for skilled nursing care pursuant to Title XVIII of the Social Security Act. On a statewide basis, a maximum of one hundred eighty skilled nursing beds which are medicare certified only may be developed pursuant to this subsection. The state health plan shall not be applicable to projects submitted under this subsection. The health care cost review authority state agency shall adopt rules to implement this subsection which shall include the following:
(1) A requirement that the one hundred eighty beds are to be distributed on a statewide basis;
(2) There shall be a minimum of twenty beds and a maximum of sixty beds in each approved unit;
(3) The unit developed by the retirement life care center shall meet all federal and state licensing certification and operational requirements applicable to nursing homes;
(4) The retirement center must demonstrate a need for the project;
(5) The retirement center must offer personal care, home health services and other lower levels of care to its residents; and
(6) The retirement center must demonstrate both short and long-term financial feasibility.
Nothing in this subsection shall negatively affect the rights of inspection and certification which are otherwise required by federal law or regulations or by this code of duly adopted rules regulations of an authorized state entity.
(k) The provisions of this article are severable and if any provision, section or part thereby shall be held invalid, unconstitutional or inapplicable to any person or circumstance, such invalidity, unconstitutionality or inapplicability shall not affect or impair any other remaining provisions contained herein.
 § 16 - 2D - 6. Minimum criteria for certificate of need reviews.
(a) Except as provided in subsections (f) and subsection (g) (f) of this section nine of this article, in making its determination as to whether a certificate of need shall be issued, the state agency shall, at a minimum, consider all of the following criteria that are applicable: but in the case of a health maintenance organization or an ambulatory care facility or health care facility controlled, directly or indirectly, by a health maintenance organization or combination of health maintenance organizations, the criteria considered shall be only those set forth in subdivision (12) of this subsection: Provided, That the criteria set forth in subsection (f) of this section shall apply to all hospitals, nursing facilities, and health care facilities when ventilator services are to be provided for any nursing facility bed:
(1) The recommendation of the designated health systems agency for the health service area in which the proposed new institutional health service is to be located;
(2) (1) The relationship of the health services being reviewed to the state health plan and other policies of the health care authority and to the applicable health systems plan and annual implementation plan adopted by the designated health systems agency for the health service area in which the proposed new institutional health service is to be located;
(3) (2) The relationship of the services reviewed to the long-range development plan of the person providing or proposing such services;
(4) (3) The need that the population served or to be served by such services has for such services proposed to be offered or expanded, and the extent to which all residents of the area, and in particular low income persons with low incomes, racial and ethnic minorities, women, handicapped persons with disabilities, other medically underserved population, and the persons who are elderly, are likely to have access to those services;
(5) (4) The availability of less costly or more effective alternative methods of providing such services to be offered, expanded, reduced, relocated or eliminated;
(6) (5) The immediate and long-term financial feasibility of the proposal as well as the probable impact of the proposal on the costs of and charges for providing health services by the person proposing the new institutional health service;
(7) (6) The relationship of the services proposed to the existing health care system of the area in which such services are proposed to be provided and, specifically, the role such services play in providing a continuum of care for the persons served or to be served by such services;
(8) (7) In the case of health services proposed to be provided, the availability of resources, including health care providers, management personnel, and funds for capital and operating needs, for the provision of the services proposed to be provided and the need for alternative uses of these resources as identified by the state health plan, applicable health systems plan and annual implementation plan;
(9) (8) The appropriate and nondiscriminatory utilization of existing and available high-tech and diagnostic facilities, equipment and health care providers;
(10) (9) The relationship, including the organizational relationship, of the health services proposed to be provided to ancillary or support services;
(11 (10) Special needs and circumstances of those entities which provide a substantial portion of their services or resources, or both, to individuals not residing in the health service areas in which the entities are located or in adjacent health service areas. Such entities may include medical and other health professional schools, multidisciplinary clinics and specialty centers;
(12) To the extent not precluded by subdivision (1), subsection (f), section nine of this article, the special needs and circumstances of health maintenance organizations. These needs and circumstances shall be limited to:
(A) The needs of enrolled members and reasonably anticipated new members of the health maintenance organization for the health services proposed to be provided by the organization; and
(B) The availability of the new health services from nonhealth maintenance organization providers or other health maintenance organizations in a reasonable and cost-effective manner which is consistent with the basic method of operation of the health maintenance organization. In assessing the availability of these health services from these providers, the agency shall consider only whether the services from these providers:
(i) Would be available under a contract of at least five years duration;
(ii) Would be available and conveniently accessible through physicians and other health professionals associated with the health maintenance organization;
(iii) Would cost no more than if the services were provided by the health maintenance organization; and
(iv) Would be available in a manner which is administratively feasible to the health maintenance organization;
(13) (11) The special needs and circumstances of biomedical and behavioral research projects which are designed to meet a national need and for which local conditions offer special advantages approved by the health care authority;
(14) (12) In the case of a reduction or elimination of a service, including the relocation of a facility or a service, the need that the population presently served has for the service, the extent to which that need will be met adequately by the proposed relocation or by alternative arrangements, and the effect of the reduction, elimination or relocation of the service on the ability of low income persons with low incomes, racial and ethnic minorities, women, handicapped persons with disabilities, other medically underserved population, and the persons who are elderly, to obtain needed health care;
(15) (13) In the case of a construction project: (A) The cost and methods of the proposed construction, including the costs and methods of energy provision and (B) the probable impact of the construction project reviewed on the costs of providing health services by the person proposing such construction project and on the costs and charges to the public of providing health services by other persons;
(16) (14) In the case of health services proposed to be provided, the effect of the means proposed for the delivery of proposed health services on the clinical needs of health professional training programs in the area in which such services are to be provided;
(17) (15) In the case of health services proposed to be provided, if such services are to be available in a limited number of facilities, the extent to which the schools in the area for health professions will have access to the services for training purposes;
(18) (16) In the case of health services proposed to be provided, the extent to which such proposed services will be accessible to all the residents of the area to be served by such services;
(19) (17) In accordance with subsections (d) and (e), section five of this article, the factors influencing the effect of competition on the supply of the health services being reviewed and the advancement of quality assurance, cost effectiveness and access;
(20) (18) Improvements or innovations in the financing and delivery of health services which foster competition, in accordance with section five of this article, and serve to promote quality assurance and cost effectiveness;
(21) (19) In the case of health services or facilities proposed to be provided, the efficiency and appropriateness of the use of existing services and facilities similar to those proposed;
(22) (20) In the case of existing services or facilities, the quality of care provided by such services or facilities in the past;
(23) In the case where an application is made by an osteopathic or allopathic facility for a certificate of need to construct, expand, or modernize a health care facility, acquire major medical equipment, or add services, the need for that construction, expansion, modernization, acquisition of equipment, or addition of services shall be considered on the basis of the need for and the availability in the community of services and facilities for osteopathic and allopathic physicians and their patients. The state agency shall consider the application in terms of its impact on existing and proposed institutional training programs for doctors of osteopathy and medicine at the student, internship, and residency training levels;
(24) The special circumstances of health care facilities with respect to the need for conserving energy;
(25) (21) The contribution of the proposed service in meeting the health related needs of members of medically underserved populations which have traditionally experienced difficulties in obtaining equal access to health services, particularly those needs identified in the state health plan, applicable health systems plan and annual implementation plan, as deserving of priority. For the purpose of determining the extent to which the proposed service will be accessible, the state agency shall consider:
(A) The extent to which medically underserved populations currently use the applicant's services in comparison to the percentage of the population in the applicant's service area which is medically underserved, and the extent to which medically underserved populations are expected to use the proposed services if approved;
(B) The performance of the applicant in meeting its obligation obligations if any, under any applicable federal regulations, laws or rules regulations requiring provision of uncompensated care, community service, or access by minorities and handicapped persons with disabilities to programs receiving federal financial assistance, including the existence of any civil rights access complaints against the applicant;
(C) The extent to which medicare, medicaid and medically indigent patients are served by the applicant; and
(D) The extent to which the applicant offers a range of means by which a person will have access to its services, including, but not limited to, outpatient services, admission by house staff and admission by personal physician. ;
(26) (22) The existence of a mechanism for soliciting consumer input into the health care facility's decision making process; and
(23) The extent to which the equipment, technology or other facilities will be owned or used by more than one health care provider to improve quality or reduce overall costs to the state's health care delivery system, or both, and, if so, the benefits of such joint ownership or use.
(b) The state agency may include consider additional criteria which it prescribes prescribed by regulations rules adopted pursuant to section eight of this article.
(c) Criteria for reviews may vary according to the purpose for which a particular review is being conducted or the types of health services being reviewed.
(d) An application for a certificate of need may not be made subject to any criterion not contained in this article, the state health plan, or not contained in regulations rules adopted pursuant to section eight of this article.
(e) In the case of any proposed new institutional health service, the state agency may not grant a certificate of need under its certificate of need program unless, after consideration of the appropriateness of the use of existing facilities providing services similar to those being proposed, the state agency makes, in addition to findings required in section nine of this article, each of the following findings in writing: (1) That superior alternatives to such services in terms of cost, efficiency and appropriateness do not exist and the development of such alternatives is not practicable; (2) that existing facilities providing services similar to those proposed are being used in an appropriate and efficient manner; (3) that in the case of new construction, alternatives to new construction, such as modernization or sharing arrangements, have been considered and have been implemented to the maximum extent practicable; and (4) that patients will experience serious problems in obtaining care of the type proposed in the absence of the proposed new service; and (5) that in the case of a proposal for the addition of beds for the provision of skilled nursing or intermediate care services, the addition will be consistent with the plans of other agencies of the state responsible for the provision and financing of long-term care facilities or services including home health services.
(f) In the case where an application is made by a hospital, nursing home or other health care facility to provide ventilator services which have not previously been provided for a nursing facility bed, the state agency shall consider the application in terms of the need for the service and whether the cost exceeds the level of current medicaid services. No facility may, by providing ventilator services, provide a higher level of service for a nursing facility bed without demonstrating that the change in level of service by provision of the additional ventilator services will result in no additional fiscal burden to the state.
 § 16 - 2D - 7. Procedures for certificate of need reviews.
(a) Prior to submission of an application for a certificate of need, the state agency shall require the submission of long-range plans by health care facilities with respect to the development of proposals subject to review under this article. The plans shall be in such form and contain such information as the state agency shall require.
(b) An application for a certificate of need shall be submitted to the state agency prior to the offering or development of all new institutional services within this state. Persons proposing new institutional health services shall submit letters of intent not less than fifteen days prior to submitting an application. The letters of intent shall be of such detail as specified by the state agency.
(c) The state agency may adopt regulations rules pursuant to section eight of this article for:
(1) Provision for applications to be submitted in accordance with a timetable established by the state agency;
(2) Provision for such reviews to be undertaken in a timely fashion; and
(3) Except for proposed new institutional health services which meet the requirements for consideration under subsection (g) (f) section nine of this article with regard to the elimination or prevention of certain imminent safety hazards or to comply with certain licensure or accreditation standards, provision for all completed applications pertaining to similar types of services, facilities or equipment to be considered in relation to each other, at least three times a year.
(d) An application for a certificate of need shall specify the time the applicant will require to make such service or equipment available or to obligate such expenditure and a timetable for making such service or equipment available or obligating such expenditure.
(e) The application shall be in such form and contain such information as the state agency shall establish by rule or regulation, but requests for information shall be limited to only that information which is necessary for the state agency to perform the review.
(f) Within fifteen days of receipt of application, the state agency shall determine if the application is complete. The state agency may request additional information from the applicant.
(g) The state agency shall provide timely written notice to the applicant and to all affected persons of the beginning of the review, and to any person who has asked the state agency to place the person's name on a mailing list maintained by the state agency. Notification shall include the proposed schedule for review, the period within which a public hearing during the course of the review may be requested by affected persons, which period may not be less than thirty days from the date of the written notification of the beginning of the review required by this section, and the manner in which notification will be provided of the time and place of any public hearing so requested. For the purposes of this subsection, the date of notification is the date on which the notice is sent or the date on which the notice appears in a newspaper of general circulation, whichever is later.
(h) Written notification to members of the public and third-party payers may be provided through newspapers of general circulation in the applicable health service area to be served by the proposed health services and public information channels; notification to all other affected persons shall be by mail which may be as part of a newsletter.
(i) If, after a review has begun, the state agency requires the person subject to the review to submit additional information respecting the subject of the review, such person shall be provided at least fifteen days to submit the information and the state agency shall, at the request of such person, extend the review period by fifteen days. This extension applies to all other applications which have been considered in relation to the application for which additional information is required.
(j) The state agency shall adopt schedules for reviews which provide that no review may, to the extent practicable, take longer than ninety days from the date that notification, as described under subsection (g) of this section, is sent to the applicant to the date of the final decision of the state agency, and in the case of expedited applications, may by regulations rules adopted pursuant to section eight of this article provide for a shortened review period.
(k) The state agency shall adopt criteria for determining when it would not be practicable to complete a review within ninety days.
(l) The state agency shall provide a public hearing in the course of agency review if requested by any affected person and the state agency may on its own initiate such a public hearing.
(1) The state agency shall, prior to such hearing, provide notice of such hearing and shall conduct such hearing in accordance with administrative hearing requirements in article five, chapter twenty-nine-a of this code, and its procedure adopted pursuant to this section.
(2) In a hearing any person has the right to be represented by counsel and to present oral or written arguments and evidence relevant to the matter which is the subject of the hearing. Any person affected by the matter which is the subject of the hearing may conduct reasonable questioning of persons who make factual allegations relevant to such matter.
(3) The state agency shall maintain a verbatim record of the hearing.
(4) After the commencement of a hearing on the applicant's application and before a decision is made with respect to it, there may be no ex parte contacts between (a) (A) the applicant for the certificate of need, any person acting on behalf of the applicant or holder of a certificate of need, or any person opposed to the issuance of a certificate for the applicant and (b) (B) any person in the state agency who exercises any responsibility respecting the application.
(5) The state agency may not impose fees for such a public hearing.
(m) If a public hearing is not conducted during the review of a new institutional health service, the state agency may, by regulations rules adopted pursuant to section eight of this article, provide for a file closing date during the review period after which date no other factual information or evidence may be considered in the determination of the application for the certificate of need. A detailed itemization of documents in the state agency file on a proposed new institutional health service shall, on request, be made available by the state agency at any time before the file closing date.
(n) The extent of additional information received by the state agency from the applicant for a certificate of need after a review has begun on the applicant's proposed new institutional health service, with respect to the impact on such new institutional health service and additional information which is received by the state agency from the applicant, may be cause for the state agency to determine the application to be a new proposal, subject to a new review cycle.
(o) The state agency shall in timely fashion notify, upon request, providers of health services and other persons subject to review under this article of the status of the state agency review of new institutional health services subject to review, findings made in the course of such review, and other appropriate information respecting such review.
(p) The state agency shall prepare and publish, at least annually, reports of reviews completed and being conducted, with general statements about the status of each review still in progress and the findings and rationale for each completed review since the publication of the last report.
(q) The state agency shall provide for access by the general public to all applications reviewed by the state agency and to all other pertinent written materials essential to agency review.
(r) (1) Any person may request in writing a public hearing for purposes of reconsideration of a state agency decision. No fees may be imposed by the state agency for the hearing. For purposes of this section, a request for a public hearing for purposes of reconsideration shall be deemed to have shown good cause if, in a detailed statement, it:
(A) Presents significant, relevant information not previously considered by the state agency, and demonstrates that with reasonable diligence the information could not have been presented before the state agency made its decision;
(B) Demonstrates that there have been significant changes in factors or circumstances relied upon by the state agency in reaching its decision;
(C) Demonstrates that the state agency has materially failed to follow its adopted procedures in reaching its decision; or
(D) Provides such other bases for a public hearing as the state agency determines constitutes good cause.
(2) To be effective, a request for such a hearing shall be received within thirty days after the date upon which all parties received notice of the state agency decision, and the hearing shall commence within thirty days of receipt of the request.
(3) Notification of such public hearing shall be sent, prior to the date of the hearing, to the person requesting the hearing, and the person proposing the new institutional health service, applicant and shall be sent to others upon request.
(4) The state agency shall hold public reconsideration hearings in accordance with the provisions for administrative hearings contained in:
(A) Its adopted procedures;
(B) Ex parte contact provisions of subdivision (4), subsection (l) of this section; and
(C) The administrative procedures for contested cases contained in article five, chapter twenty-nine-a of this code.
(5) The state agency shall make written findings which state the basis for its decision within forty-five days after the conclusion of such hearing.
(6) A decision of the state agency following a reconsideration hearing shall be considered a decision of the state agency for purposes of sections nine and ten of this article and for purposes of the notification of the status of review, findings and annual report provisions of subsections (o) and (p) of this section.
(s) The state agency may adopt regulations rules pursuant to section eight of this article for reviews and such regulations may vary according to the purpose for which a particular review is being conducted or the type of health services being reviewed.
(t) Notwithstanding other provisions of this article, the state agency shall adopt rules and regulations for determining when there is an application which warrants expedited review. If procedures adopted by the state agency to handle expedited applications do not conform to the provisions of this article, such procedures shall be approved by the federal secretary of health and human services and shall be adopted as regulations pursuant to section eight of this article.
§ 16 - 2D - 8. State Agency to promulgate additional rules; and regulations.

(a) The state agency is hereby empowered to may promulgate additional rules and regulations to:

(1) To carry out the provisions of this article; and
(2) To assure hospitals' compliance with requests for information concerning rates charged for each of the twenty-five most frequently used designated hospital services, in the state including the average semiprivate and private room rates; and
(3) Require ambulatory care centers to submit requested information;
(4) Assure timely and accurate reporting of budgeted and actual capital expenses.
(5) Set standards for shared services and equipment, mobile or fixed, to encourage cost-effective cooperative arrangements among health care providers.
(b) All rules and regulations shall be promulgated pursuant to chapter twenty-nine-a of this code. Code and as described herein. In addition, before adopting proposed rules and regulations the state agency shall give interested persons an opportunity to offer written comments on the rules and regulations, or any revisions thereof, which it proposes to adopt, as follows:
(1) The state agency shall distribute copies of its proposed review rules and regulations, and proposed revisions thereof, to statewide health agencies and organizations, the statewide health coordinating council, and each health systems agency for a health service area located in whole or in part within the state and any agency which establishes rates for health care facilities in the state;
(2) The state agency shall publish, in at least one newspaper in each planning and development region in this state, a notice stating that rules and regulations for review of certificate of need applications or any revisions thereof, have been proposed for adoption and are available at specified addresses for inspection and copying by interested persons. In addition, notice may be given through other public information channels; and
(3) The state agency shall distribute copies of its adopted review rules and regulations, and any revisions thereof, to the agencies and organizations specified in this section and to the secretary of health and human services, and shall provide such copies to other persons upon request.
§ 16 - 2D - 9. State agency to render final decision; issue certificate of need; capital allocation; write findings; specify capital expenditure maximum.

(a) Only the state agency, or the appropriate administrative or judicial review body, may issue, deny or withdraw certificates of need, grant exemptions from certificate of need reviews, or determine that certificate of need reviews are not required.

(b) Except as provided in subsection (f) of this section, a A certificate of need may only be issued if the proposed new institutional health service is:
(1) Found to be needed; and
(2) Except in emergency circumstances that pose a threat to public health, consistent with the state health plan and other policies of the health care authority; and
(3) Within the applicable capital allocation. Provided, That if a health care facility which is controlled, directly or indirectly, by a health maintenance organization applies for a certificate of need for a proposed new institutional health service, the state agency may not disapprove the application solely because such an institutional health service is not discussed in the state health plan or annual implementation plan.
(c) The state agency shall render a final decision on every application for a certificate of need or application for exemption in the form of an approval, a denial, or an approval with conditions. Any decision of the state agency with respect to a certificate of need, or exemption, shall be based solely on:
(1) The review of the state agency conducted in accordance with procedures and criteria in this article and in regulations rules adopted pursuant to section eight of this article; and
(2) The record established in administrative proceedings held with respect to the certificate of need or exemption.
(d) Approval with conditions does not give the state agency authority to mandate new institutional health services not proposed by the health care facility or health maintenance organization applicant. Issuance of a certificate of need or exemption may not be made subject to any condition unless the condition directly relates to criteria included or referenced in this article or in rules and regulations adopted pursuant to section eight of this article. Conditions may be imposed upon the operations of the health care facility or health maintenance organization for no longer than a three-year period. Compliance with such conditions may be enforced through the mechanisms detailed in section thirteen of this article.
(e)(1) For each proposed new institutional health service it approves, the state agency shall, in addition to the written findings required in subsection (e), section six of this article, make a written finding, which shall take into account the current accessibility of the facility as a whole, on the extent to which the new institutional health service will meet the criteria in subdivisions (4), (14) and (25) (3), (12) and (21), subsection (a), section six of this article, regarding the needs of medically underserved population populations, except in the following cases:
(A) Where the proposed new institutional health service is one described in subsection (g) (f) of this section to eliminate or prevent certain imminent safety hazards or to comply with certain licensure or accreditation standards; or
(B) Where the new institutional health service is a proposed capital expenditure not directly related to the provision of health services or to beds or major medical equipment; or
(C) Where the new institutional health service is proposed by or on behalf of a health care facility which is controlled, directly or indirectly, by a health maintenance organization.
(2) If the state agency disapproves a proposed new institutional health service for failure to meet the needs of medically underserved populations, it shall so state in a written finding.
(f) (1) Notwithstanding review criteria in subdivision (12), subsection (a), section six of this article, if a health care facility which is controlled, directly or indirectly, by a health maintenance organization applies for a certificate of need, such application shall be approved by the state agency if the state agency finds, in accordance with criteria prescribed by the state agency by regulations adopted pursuant to section eight of this article, that:
(A) Approval of such application is required to meet the needs of the members of the health maintenance organization and of the new members which such organization can reasonably be expected to enroll; and
(B) The health maintenance organization is unable to provide, through services or facilities which can reasonably be expected to be available to the organization, its institutional health services in a reasonable and cost- effective manner which is consistent with the basic method of operation of the organization and which makes such services available on a long-term basis through physicians and other health professionals associated with it.
(2) Except as provided in subdivision (1), subsection (b), section four of this article, a health care facility, or any part thereof, or medical equipment with respect to which a certificate of need was issued under this subsection, may not be sold or leased, and a controlling interest in such facility or equipment or in a lease of such facility or equipment may not be acquired unless the state agency issues a certificate of need approving the sale, acquisition or lease.
(g) (f) (1) Notwithstanding review criteria in section six of this article, an application for a certificate of need shall be approved, if the state agency finds that the facility or service with respect to which such capital expenditure is proposed to be made is needed and that the obligation of such capital expenditure is consistent with the state health plan and other policies of the health care authority, for a capital expenditure which is required:
(A) To eliminate or prevent imminent safety hazards as defined by federal, state or local fire, building or life safety codes or regulations;
(B) To comply with state licensure standards; or
(C) To comply with accreditation or certification standards, compliance with which is required to receive reimbursements under Title XVIII of the Social Security Act or payments under the state plan for medical assistance approved under Title XIX of such act.
(2) An application for a certificate of need approved under this subsection shall be approved only to the extent that the capital expenditure is required to eliminate or prevent the hazards described in subparagraph paragraph (A), subdivision (1), of this subsection (g), or to comply with the standards described in either subparagraph paragraph (B) or (C), subdivision (1), of this subsection (g) of this section.
(h) (g) The state agency shall send its decision along with written findings to the person proposing the new institutional health service or exemption applicant and all other parties to the proceeding and shall make it available to others upon request.
(2) In the case of a new institutional health service proposed by a health maintenance organization, the state agency shall send the written findings to the appropriate regional office of the federal department of health and human services at the time they are sent to the applicant.
(3) In any decision where the state agency finds that a proposed new institutional health service does not satisfy the criteria in subdivisions (4), (14), and (25), subsection (a), section six of this article, regarding the needs of medically underserved population, it shall so notify in writing the applicant and the appropriate regional office of the federal department of health and human services.
(i) In the case of a final decision to approve or approve with conditions a proposal for a new institutional health service, the state agency shall issue a certificate of need to the person proposing the new institutional health service.
(j) (h) The state agency shall specify in the certificate the maximum amount of capital expenditures which may be obligated under such certificate. The state agency shall prescribe the method used to determine capital expenditure maximums and shall adopt regulations rules pursuant to section eight of this article for the review of approved new institutional health services for which the capital expenditure maximum is exceeded or is expected to be exceeded.
(k) (i) If the state agency fails to make a decision within the time period specified for the review, the applicant may, within one year following the expiration of such period, bring an action, at the election of the applicant, in either the circuit court of Kanawha County, or with the judge thereof in vacation, or in the circuit court of the county in which the applicant or any one of the applicants resides or does business, or with the judge thereof in vacation to require the state agency to approve or disapprove the application. An application for a proposed new institutional health service or exemption may not be approved or denied by the circuit court solely because the state agency failed to reach a decision.
§ 16 - 2D - 10. Appeal of certificate of need and notice of substantial compliance decisions.

(a) A final decision of the state agency, including a state agency decision issued after a reconsideration, if such reconsideration was requested and granted under subsection (t) (r), section seven of this article, and including a final decision regarding withdrawal of a certificate of need or notice of substantial compliance in accordance with section eleven of this article, and the record upon which it was made, shall, upon request of any affected person, or the applicable health systems agency if the decision is inconsistent with a recommendation made by the applicable health systems agency to the state agency with respect to the certificate of need, be reviewed by an agency of the state (other than the state agency) designated by the governor. To be effective, such request shall be received within thirty days after the date upon which all parties received notice of the state agency decision, and the hearing shall commence within thirty days of receipt of the request.

(b) To the extent not inconsistent with this section, for the purpose of administrative reviews of state agency decisions, the review agency shall conduct its proceedings in conformance with the West Virginia rules of civil procedure for trial courts of record and the local rules for use in the civil courts of Kanawha County and shall review appeals in accordance with the provisions governing the judicial review of contested administrative cases in section (4), article five, chapter twenty-nine-a of this code, notwithstanding the exceptions of section five, article five, chapter twenty-nine-a of this code.
(c) The decision of the reviewing review agency shall be made in writing within forty-five days after the conclusion of such hearing.
(d) The written findings of the review agency shall be sent to the person who requested the review, to the person proposing the new institutional health service, to the health systems agency requesting a review applicant and to the state agency, and shall be made available by the state agency to others upon request.
(e) The decision of the reviewing review agency shall be considered the final decision of the state agency; however, the reviewing agency may remand the matter to the state agency for further action or consideration.
(f) Upon the entry of a final decision by the reviewing review agency the designated health systems agency, if the decision respecting the certificate of need is inconsistent with a recommendation made by that health systems agency to the state agency with respect to the certificate of need, and any other "person adversely affected by the review" have has standing in and may within thirty days after the date upon which all parties received notice of the decision of the review agency take an appeal at the election of the petitioner, in either the circuit court of Kanawha County, or in the circuit court of the county in which the petitioner or any of the petitioners resides or does business, from any decision of the state agency granting, with or without conditions, denying or withdrawing a certificate of need or exemption or a notice of compliance. The decision of the review agency shall be reviewed by such circuit court in accordance with the provisions for the judicial review of administrative decisions contained in section four, article five, chapter twenty-nine-a of this code. For the purposes of this subsection, "person adversely affected by the review" includes the state agency, any person who meets the definition of affected person in section two of this article, and any person who participated in the proceeding before the state agency.
§ 16 - 2D - 11. Nontransference, time period compliance, notice of substantial compliance and withdrawal of certificate of need . or notice of substantial compliance.

(a) A certificate of need is nontransferable and shall be valid for a maximum of one year from the date of issuance. A transfer includes the sale, lease, transfer of stock or partnership shares, or other comparable arrangement which has the effect of transferring the control of the owner of the certificate of need. Upon the expiration of the certificate or during the certification period, the person proposing the new institutional health service applicant shall provide the state agency such information on the development of the project as the state agency may request. The state agency shall periodically monitor capital expenditures obligated under certificates, determine whether sufficient progress is being made in meeting the timetable specified in the approved application for the certificate and whether there has been compliance with the application and any conditions of certification. The state agency shall take into account recommendations made by the health systems agency in making its determination. The certificate of need may be extended by the state agency for additional periods of time as are reasonably necessary to expeditiously complete the project. A certificate of need may shall no longer be in effect and may no longer be required, after written notice of substantial compliance with the approved application and any conditions of certification is issued to the applicant, after the activity is undertaken for which the certificate of need was issued, and after the state agency is provided written notice of such undertaking. The person proposing a new institutional health service applicant may not be issued a license therefor for the new institutional health service until the state agency has issued a written notice of substantial compliance with the approved application and any conditions of certification, nor may a new institutional health service be used until such person the applicant has received such notice. A new institutional health service may not be found to be in substantial compliance with the approved application and any conditions of certification if there is a substantial change, as defined in regulations adopted pursuant to subsection (i) (j), section three of this article, in the approved new institutional health service for which change a certificate of need has not been issued.

(b)(1) The certificate of need may be withdrawn by the state agency for:
(A) (1) Insufficient progress in meeting the timetable specified in the approved application for the certificate and for not making a good faith effort to meet it in developing the project; or
(B) (2) Noncompliance with any conditions of certification; or
(C) (3) A substantial change, as defined in regulations adopted pursuant to subsection (i), section three of this article, in an approved new institutional health service for which change a certificate of need has not been issued; or
(D (4)) Material misrepresentation by an applicant upon which the state agency relied in making its decision; or
(E (5)) Other reasons that may be established by the state agency in regulations adopted pursuant to section eight of this article.
(c) The state agency shall review each notice of substantial compliance issued in connection with a certificate of need, the application for which was filed on or after the first day of July, one thousand nine hundred ninety-four. The review shall occur annually during the thirty-day period succeeding each of the first five anniversaries of issuance of the notice. During the thirty-day period preceding the anniversary, the holder of the notice of substantial compliance shall submit to the state agency such information as shall be required by rules adopted pursuant to section eight of this article. Such rules shall require, among other things, financial information regarding the project, which information shall be compared by the state agency with the projections presented to it in connection with issuance of the certificate of need. If the state agency finds that a substantial change has been made to or otherwise occurred in the project for which the notice of substantial compliance was issued, and determines that the applicant knew or should have known about the need for change prior to the issuance of the certificate of need, or if the state agency finds that the financial projections presented to the state agency in connection with the application were substantially inaccurate and determines that the applicant knew or should have known about such inaccuracy, the state agency may withdraw the notice of substantial compliance or take any other actions authorized by this article and shall submit its findings and recommendations for action in writing to the applicable licensing entity. The licensing entity shall determine whether to impose conditions on, suspend or revoke the license of the health care provider for the project. The state agency may refuse to allow any increase in rates for the health care provider to recover any increase in the costs of acquisition, construction or operation which the state agency determines the health care provider knew or should have known were not accurately reflected in its financial projections.
(2) (d) Any decision of the state agency to withdraw a certificate of need or notice of substantial compliance shall be based solely on:
(A) (1) The provisions of this article and on regulations rules adopted in accordance with section eight of this article; and
(B) (2) The record established in administrative proceedings held with respect to the state agency's proposal to withdraw the certificate or notice of substantial compliance.
(3) (e) In the case of a proposed withdrawal of a certificate of need:
(A) (1) After commencement of a hearing on the state agency's proposal to withdraw a certificate of need or notice of substantial compliance and before a decision is made on withdrawal, there may be no ex parte contacts between (i) (A) the holder of the certificate of need or notice of substantial compliance, any person acting on behalf of the holder, or any person in favor of the withdrawal and (ii) (B) any person in the state agency who exercises responsibility respecting withdrawal of the certificate or notice;
(B) (2) The state agency shall follow the notification of review provisions of subsections (g) and (h), the public hearing provisions of subsection (n) (1), the notification of the status of review and findings provisions of subsection (g) (o), the annual report provisions of subsection (r) (p), and the reconsideration provisions of subsection (t) (r), all of section seven of this article, and the conditional decision provisions of subsection (d), the notification of decision and findings provisions of subsection (h) (g), and the statement to the applicable health systems agency provisions of subsection (k), all of section nine of this article; and
(C) (3) Appeals of withdrawals of certificates of need or substantial compliance shall be made pursuant to section ten of this article.
(4) (f) A new institutional health service may not be acquired, offered, or developed within this state if a certificate of need authorizing, or the notice of substantial compliance for, that new institutional health service has been withdrawn by the state agency and the acquisition, offering, or development or operation of the new institutional health service is subject to review under this article.
§ 16 - 2D - 12. Denial or revocation of license for operating without certificate or notice of substantial compliance.

Any person acquiring, offering or developing any new institutional health service for which a certificate of need is required under this article without first obtaining a certificate of need therefor or any person operating an institutional health service for which a notice of substantial compliance is required to be maintained under this article without maintaining a notice of substantial compliance therefor, both as herein provided, or who violates any of the provisions of this article is subject to denial or revocation of a license, in whole or in part, to operate such institutional health service or facility. Upon a showing to the state agency that any person is offering or developing any new institutional health service within the meaning of this article without having first obtained a certificate of need therefor or is operating a new institutional health service without maintaining a notice of substantial compliance for the time period required therefor as provided herein, or that such person is otherwise in violation of the provisions of this article, the state agency shall provide such person with written notice, which notice shall state the nature of the violation and the time and place at which such person shall appear to show good cause why its license should not be revoked or denied, at which time and place such person shall be afforded a reasonable opportunity to present testimony and other evidence in support of its position. If, thereafter, the state agency determines that such person's license to operate such institutional health service or facility should be revoked or denied, the state agency shall issue an order, in writing, to the appropriate responsible licensing agency of the state, requiring that such person's license to operate such institutional health service or facility be revoked or denied, which order shall be binding upon such licensing agency.

 § 16 - 2D - 13. Injunctive relief; civil penalty.
(a) In addition to all other remedies, and aside from various penalties provided by law, if any person acquires, offers or, develops or operates any new institutional health service for which a certificate of need or notice of substantial compliance is required under this article without first having a certificate of need therefor or a notice of substantial compliance therefor as herein provided, or violates any other provision of this article or any lawful rule or regulation promulgated thereunder, affected persons, as defined in section two of this article, and the state agency shall request that the attorney general maintain a civil action in the circuit court of the county wherein such violation has occurred, or wherein such person may be found, to enjoin, restrain or prevent such violation. No injunction bond shall be required to be filed in any such proceeding.
(b) The state agency may assess a civil penalty for violation of this article. Upon the state agency determining that there is probable cause to believe that any person is knowingly offering, developing, or has acquired any new institutional health service subject to certificate of need review without having first obtained a certificate of need therefor or is knowingly operating a new institutional health service without maintaining a notice of substantial compliance for the time period required therefor, as applicable, or that any person is otherwise in violation of the provisions of this article, or any lawful rule or regulation promulgated thereunder, the state agency shall provide such person with written notice which shall state the nature of the alleged violation and the time and place at which such person shall appear to show good cause why a civil penalty should not be imposed, at which time and place such person shall be afforded an opportunity to cross-examine the state agency's witnesses and afforded an opportunity to present testimony and other evidence in support of his position. The hearing shall be conducted in accordance with the administrative hearing provisions of section four, article five, chapter twenty-nine-a of this code. If, after reviewing the record of such hearing, the state agency director determines that such person is in violation of the certificate of need law, the state agency shall assess a civil penalty of not less than five hundred dollars nor more than twenty-five thousand dollars. In determining the amount of the penalty, the state agency shall consider the degree and extent of harm caused by the violation and the cost of rectifying the damage. Any person assessed shall be notified of the assessment in writing, and the notice shall specify the reasons for the assessment. If the person assessed fails to pay the amount of the assessment to the state agency within thirty days, the attorney general may institute a civil action in the circuit court of the county wherein such violation has occurred, or wherein such person may be found to recover the amount of the assessment. In any such civil action, the scope of the court's review of the state agency's action, which shall include a review of the amount of the assessment, shall be as provided in section four, article five, chapter twenty-nine-a of this code for the judicial review of contested administrative cases.
§ 16 - 2D - 15. Previously approved rules; health care authority policies and recommendations.

All rules and regulations previously promulgated to implement this article shall continue in force following the amendments to this article; except that, where such previous rules and regulations differ from the requirements of the amendments to this article or requirements of the state health plan then such part of those rules and regulations are hereby abrogated and shall have no further legal effect. All other rules of the state agency shall continue in force until superseded or repealed. The state agency shall commence a review of such its rules and regulations and shall, no later than the first day of July, one thousand nine hundred ninety-five, promulgate revised rules and regulations consistent with the legislation making such amendments, the state health plan and other policies of the health care authority.

It is anticipated that, as a consequence of the measures envisioned within the West Virginia Health Care Access and Reform Act of 1994, the factors which now necessitate the certificate of need process required by this article may no longer be necessary and will be replaced by increased community involvement and the development of appropriate financial incentives as the basis for decisions regarding capital expenditures by health care providers and investors. To that end, after the implementation of the rate-setting and provider self-referral provisions as set forth in that act, the health care authority created in section five, article one, chapter sixteen-a of this code may make recommendations to the governor and the Legislature as to the discontinuance or modification of any or all of the certificate of need provisions of this article.
 ARTICLE 3. PREVENTION AND CONTROL OF COMMUNICABLE AND OTHER INFECTIOUS DISEASES.
§ 16 - 3 - 5. Distribution of free vaccine preventives of disease.

(a) Declaration of legislative findings and purpose. -- The Legislature finds and declares that early immunization for preventable diseases represents one of the most cost-effective means of disease prevention. The savings which can be realized from immunization, compared to the cost of health care necessary to treat the illness and lost productivity, are substantial. Immunization of children at an early age serves as a preventative measure both in time and money and is essential to maintain our children's health and well-being. The costs of childhood immunizations should not be allowed to preclude the benefits available from a comprehensive, medically supervised child immunization service. Furthermore, the federal government has established goals that require ninety percent of all children to be immunized by age two and provided funding to allow uninsured children to meet this goal.

(b) The state director of commissioner of the bureau of public health shall acquire vaccine for the prevention of polio, measles, mumps, rubella, diphtheria, pertussis, tetanus, smallpox hepatitis-b, haemophilus influenzae-b and other vaccine preventives of disease as may be deemed necessary or required by law, and shall distribute the same, free of charge, in such quantities as he may deem necessary, to county and municipal health officers, to be used by them for the benefit of, and without expense to the citizens within their respective jurisdictions, to check contagions and control epidemics.
(c) The county and municipal health officers shall have the responsibility to properly store and distribute, free of charge, vaccines to private medical or osteopathic physicians within their jurisdictions to be utilized to check contagions and control epidemics: Provided, That the private medical or osteopathic physicians shall not make a charge for the vaccine itself when administering it to a patient. The county and municipal health officers shall provide a receipt to the state director of health for any vaccine delivered as herein provided.
(d) The department of health and human resources, commissioner of the bureau of public health is charged with establishing a childhood immunization advisory committee to plan for universal access, make recommendations on the distribution of vaccines acquired pursuant to this section and tracking of immunization compliance in accordance with federal and state laws. The childhood immunization advisory committee shall be appointed by the secretary of the department of health and human resources no later than the first day of July, one thousand nine hundred ninety-four, and shall be comprised of representatives from the following groups: public health nursing, public health officers, primary health care providers, pediatricians, family practice physicians, health care administrators, state medicaid program, the health insurance industry, the public employees insurance agency, the self-insured industry and consumers. The state epidemiologist shall serve as an advisor to the committee. Members of the advisory committee shall serve two-year terms.
(e) All health insurance policies and prepaid care policies issued in this state which provide coverage for the children of the insured shall provide coverage for child immunization services to include the cost of the vaccine, if incurred by the health care provider, and all costs of administration from birth through age sixteen years. These services shall be exempt from any deductible, per-visit charge and/or copayment provisions which may be in force in these policies or contracts. This section does not exempt other health care services provided at the time of immunization from any deductible and/or copayment provisions.
(f) Attending physicians, midwives, nurse practitioners, hospitals, birthing centers, clinics and other appropriate health care providers shall provide parents of newborns and preschool age children with information on the following immunizations: diphtheria, polio, mumps, measles, rubeola, rubella, tetanus, hepatitis-b, haemophilus influenzae-b and whooping cough. This information should include the availability of free immunization services for children.
ARTICLE 29B. WEST VIRGINIA HEALTH CARE COST REVIEW AUTHORITY.

§ 16-29B-19. Rate-setting powers generally.

(a) The board shall have power: (1) To initiate reviews and investigations of hospital rates and establish and approve such rates; (2) to initiate reviews and investigations of hospital rates for specific services and the component factors which determine such rates; (3) to initiate reviews and investigations of hospital budgets and the specific components of such budgets; and (4) to approve or disapprove hospital rates and budgets taking into consideration the criteria set forth in section twenty of this article and the rules of the health care authority created by section five, article one, chapter sixteen-a of this code.

(b) In the interest of promoting the most efficient and effective use of hospital service, the board health care authority may adopt and approve, and the board shall apply, alternative methods of rate determination. The board health care authority may also adopt, and the board shall apply, methods of charges and payments of an experimental nature which are in the public interest and consistent with the purpose purposes of this article and of chapter sixteen-a of this code.
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 five, article one 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) "Medical savings account" means a trust for the payment of medical expenses created or organized for the exclusive benefit of an individual, his or her children and dependents, and his or her beneficiaries. Medical savings accounts include plans providing for payment from the trust of medical expenses included within deductible or copayment provisions of an individual or group accident and sickness insurance policy for a covered individual. A health care investment account which meets this definition is a medical savings account.
(u) "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.
(v) "Payor" means public, private, governmental and nongovernmental payors or purchasers of health care services, all in conformance with federal laws, rules and regulations.
(w) "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.
(x) "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.
(y) "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.
(z) "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.
(aa) "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.(bb) "State agency" means any division, agency, board, department, authority, bureau, commission or any other state governmental body.
(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.
(ee) "Uniform health benefits package" means the uniform high quality, medically appropriate health care services that the authority defines pursuant to section eleven of this article as those services for which universal coverage will ultimately be provided.
(ff) "Utilization review" means evaluation of the necessity, appropriateness and efficiency of the use of medical services, procedures and facilities, including, but not limited to, review of the appropriateness of admissions to health care facilities, services ordered and provided, length of stay and discharge practices, on a prospective, concurrent and retrospective basis.
§ 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. The authority shall be a governmental instrumentality and a body corporate and shall have the powers and duties set forth in this chapter.

(b) The authority shall consist of three members, each of whom shall be a citizen of West Virginia and shall be appointed by the governor with the advice and consent of the Senate. The governor shall appoint the members based on their commitment to health care reform and their knowledge of and experience and interest in health and health care. In appointing members, the governor shall consider the need for expertise in the areas of law, consumer advocacy, health planning, administration and policy, economics and finance, or medicine and public health, and any member shall have a postgraduate degree in a field related to his or her area of expertise. Not more than two of the three members of the authority shall be members of the same political party. The appointment of the initial members of the authority shall be made by the governor not later than the first day of June, one thousand nine hundred ninety-four, and all members shall assume the duties of the office not later than the first day of July, one thousand nine hundred ninety-four. The terms of the three members appointed by the governor first taking office on or after the effective date of this chapter shall expire as designated by the governor at the time of appointment, one at the end of the second year, one at the end of the fourth year and one at the end of the sixth year, after the first day of July, one thousand nine hundred ninety-four. The successor of each such appointed member shall be appointed for a term of six years in the same manner as the original appointments were made, except that any person appointed to fill a vacancy occurring prior to the expiration of the term for which his or her predecessor was appointed shall be appointed only for the remainder of such term. Each member shall serve until the appointment and qualification of his or her successor. Members may be reappointed to serve additional terms: Provided, That no member may serve more than two consecutive six-year terms.
(c) Before entering upon his or her duties, each member of the authority shall comply with the requirements of article one, chapter six of this code. The governor may remove any member only for cause as provided in article six, chapter six of this code. Within thirty days of removal or acceptance of the resignation of a member, the governor shall appoint a person, qualified as described above, to fill the vacancy.
(d) The governor shall designate a chair of the authority from among its members. Upon designation of the authority as the single state agency, the chair shall serve as chief administrator of the single state agency.
(e) Members of the authority shall serve full time in the duties of the office. The annual salary of the chair shall be ninety thousand dollars and the annual salary of the other members of the authority shall be eighty-five thousand dollars.
(f) No person while in the employ of, or holding any official relation to, any health care provider or payor subject to the provisions of this article, or who has any pecuniary interest therein, may serve as a member of the authority or as an employee thereof. Nor may any member be a candidate for or hold public office or be a member of any political committee while acting as a member; nor may any member or employee of the authority receive anything of value, either directly or indirectly, from any health care provider or payor subject to the provisions of this article. Should any member become a candidate for any public office or for membership on any political committee, the governor shall remove the member shall appoint a new member to fill the vacancy created. No member may accept employment with or as a lobbyist for any health care provider or payor within the state within two years after ceasing to be a member.
(g) 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 shall be necessary for any action taken by vote of the authority: Provided, That the governor moves to fill vacancies expeditiously. No vacancy in the membership of the authority shall impair the rights of a quorum by such vote to exercise all the rights and perform all the duties of the authority.
(h) All meetings of the authority shall be conducted and records of the authority shall be kept in accordance with the provisions of article nine-a, chapter six of the code, except that nothing in this section shall be construed to prohibit informal conversations by and between members of the authority or staff in the ordinary course of the day-to-day operations of the authority.
 § 16A-1-6. Health care authority management board; composition; meetings; quorum.
(a) Within the health care authority there is hereby created a health care management board hereinafter referred to as the "management board." The management board shall be composed of the chair of the health care authority, who shall serve as chair of the management board; the secretary of the department of health and human resources; the director of the office of medical services; the insurance commissioner; the consumer advocate in the office of the insurance commissioner; the chair of the health care cost review authority; the director of the public employees insurance agency; the vice chancellor for health sciences of the university system; the commissioner of the bureau of employment programs; the secretary of the department of administration or his or her designee; the special assistant for wellness; and such other nonvoting representatives of agencies of state government as may be designated by the board from time to time to participate in its deliberations with respect to policies and procedures affecting that agency. The secretary of the department of health and human resources may designate an employee of the department to serve on the management board in his or her stead.
(b) A majority of the members of the management board shall constitute a quorum, and a quorum must be present for the management board to act. The affirmative vote of at least a majority of the members present shall be necessary for any action taken by vote of the management board. No vacancy in the membership of the management board shall impair the rights of a quorum by such vote to exercise all the rights and perform all the duties of the board.
(c) The management board shall meet at least monthly, and more often if it deems necessary. All meetings of the management board shall be conducted and records kept in accordance with the provisions of article nine-a, chapter six of this code.
(d) The management board shall serve as an advisory body to the authority; shall coordinate health care planning in the various agencies in cooperation with the policies and priorities of the authority; and shall, on a continuing basis, plan, assign and implement tasks and goals to be accomplished within the various agencies to implement health care reform as provided for in this chapter.
 § 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 article. 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 hold public hearings on any proposed amendments or modifications to the state health plan. Following the public hearings, the authority shall submit the proposed amendments or modifications to the governor for his or her approval. The governor shall approve or reject the plan amendments or modifications within thirty days of submission, specifying the reason or reasons for rejecting any portion. If the governor rejects the plan or any portion thereof, the authority shall, within thirty days, make necessary revisions and resubmit the plan for the governor's approval. The authority shall submit to the joint committee on government and finance any and all amendments or modifications approved by the governor for that committee's review and comment.
§ 16A-1-8. Specific duties of the authority; deadlines.

(a) Advisory groups and task forces. -- 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 eighteen of this article, and shall appoint the malpractice reform task force provided for in section twenty-one of this article. The authority is authorized to form ad hoc working groups and task forces, composed of representatives of state agencies, citizens, health care providers and payors, as are necessary or desirable to achieve specific tasks and goals required by this chapter.

(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) Annual Report. -- On or before the first day of November, one thousand nine hundred ninety-four, and thereafter annually on or before the same date, the authority shall submit to the governor a report containing specific administrative and legislative recommendations for the authority's plan of action for the next state fiscal year, including, but not limited to, the reforms which it intends to implement, the policies which it intends to adopt and the revisions to the state health plan which it intends to make. The governor shall approve or reject the report within thirty days of its submission. If the governor rejects the report, the authority shall, within thirty days, make necessary revisions and resubmit the report for the governor's approval. Upon approval of the report by the governor, the authority shall submit the plan to the Legislature and each state agency involved with health care and shall make the report available to the public. Any plan or report required to be submitted to the governor or the Legislature by another section in this chapter may be combined with the annual report required by this section. The recommendations contained in the report shall be reasonably designed to:
(1) Provide, over time and within the limits of funds available, universal coverage for health care services in the uniform health care benefits package defined pursuant to section eleven of this article, Provided, That this provision shall not be construed to create an entitlement to health care services for any individual at any particular 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 effect and estimated future value of 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 Legislature, 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.
The authority may 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 one thousand nine hundred ninety-seven, detailing appropriate categories of expenditures and describing the state health programs involved in administering or regulating such expenditures. For fiscal year one thousand nine hundred ninety-eight 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 January, one thousand nine hundred ninety-five, the health care authority established by section one, article two, chapter sixteen-a of this code, shall develop a proposal regarding conflicts of interest which might create incentives for providers to base health care decisions on profit rather than optimum health care, both to protect the citizens of West Virginia from unnecessary and costly health care expenditures and to assure that medically indicated care is delivered: Provided, That such rules shall be no less restrictive than any applicable federal laws, rules or regulations. The proposal shall be submitted in the form of specific legislation for consideration by the Legislature during the next regular legislative session.
(h) Utilization review. -- The authority shall develop by legislative rules promulgated pursuant to chapter twenty-nine-a of this code not later than the first day of July, one thousand nine hundred ninety-four, a single utilization review program for all payors of health services within the state. The rules of the authority adopted to effect a single utilization review program shall consider the following:
(1) The need for health care data obtained from standardized utilization review to be analyzed.
(2) The need for the continuous quality improvement model to serve as the basis for utilization review.
(3) The need for educational programs for health care professionals and the public on health care management, emphasizing effective interactions among the various interest groups.
(4) The framework and strategies necessary for an orderly transition into a statewide utilization review and quality assurance program.
(5) The establishment of an appeal process by which providers and consumers may appeal to an impartial third party under the authority and under the office of insurance commissioner to settle utilization review disputes.
(i) Quality of care. -- The authority shall make recommendations to the Legislature relating to quality of care no later than the first day of December, one thousand nine hundred ninety-four, and each year thereafter. The authority shall consider the following:
(1) The establishment of a hospital complaint program;
(2) A comprehensive hospital quality of care oversight program;
(3) A hospital incident reporting program; and
(4) Any other matters related to improving the quality of care in the state.
 § 16A-1-9. Rates.
(a) Not later than the first day of January, one thousand nine hundred ninety-five, the authority shall promulgate by emergency rules pursuant to chapter twenty-nine-a of this code a system of payment for institutional health care providers, to be implemented by the state health care cost review authority, according to a timetable established by the authority that allows the development of appropriate data upon which to base policies and payments and consideration of the legitimate needs of the institutions affected by this section. The system developed shall be based on the medicare diagnostic related group (DRG) payment system and shall conform to the following guidelines:
(1) The DRG categories, modifiers, policies and definitions adopted by the authority shall be patterned generally after those used to determine hospital reimbursement under the federal medicare system.
(2) On at least a yearly basis, the authority shall determine a payment rate for hospital services, which generally shall be expressed as a single, uniform numerical multiplier of the DRG payment schedule established by medicare and as modified by the authority.
(3) The payment rate for selected DRG's shall be modified upward or downward by the authority if it appears that certain services produce atypical levels of profit or loss compared to other services. In making such modifications, the authority shall attempt to assure that all necessary hospital services are equally profitable, to create the incentive for hospitals to provide for the general needs of their community rather than to provide particularly profitable services or to capture particularly remunerative patients: Provided, That the authority may determine that it is appropriate for certain necessary hospital services, such as nursery services, that those services experience losses and be supported by other hospital services.
(4) The payment schedule shall be generally uniform statewide. It shall not be modified based on traditional hospital charges or fees, but, in addition to standard medicare modifiers, may be modified up to a total of eight percent upward or downward for any or all DRG's, as determined by the authority, based on one or more of the following considerations:
(i) Any difference in the cost of living between the areas in which various hospitals are located.
(ii) Any major departure from the expected severity of disease within any major DRG at any particular hospital, if adequately documented.
(iii) Payments made by hospitals to service debts owed prior to the effective date of this act to banks or other commercial lending institutions or on bonds sold to the public: Provided, That the authority may also consider payments made by hospitals to service debts owed to banks or other commercial lending institutions or on bonds owed to the public if the health care cost review authority determines on the merits that a hospital expansion project requiring additional debt justifies more debt service than is already factored into the base prospective payment rate: Provided, however, That if any hospital is owed money other than for unpaid hospital services, or if any hospital has incurred any mortgage or other lien against its assets and the proceeds of such mortgage or lien have passed from the control of the hospital board of directors or have been used for purposes that do not relate directly to the provision of health care services or for business directly related to the hospital, such payments may not be considered in reimbursement rates.
(iv) Costs of education.
(5) A downward adjustment of the reimbursement rate for any hospital shall be made for the aggregate profits from laboratory, X-ray, other diagnostic services, physical therapy services, rehabilitation services, home health services, skilled nursing services, clinics and other patient care services provided by, owned by, or otherwise financially associated with that hospital, up to the full total dollar amount of such profits and taking into account a reasonable allowance for capital costs related to such services.
(6) An additional adjustment, upward or downward, shall be made for any unusually high or low amount of uncompensated or undercompensated inpatient care provided by any hospital, the value of such services to be determined by reference to the DRG category of such care and the standard DRG reimbursement schedule.
(7) An additional downward adjustment to the reimbursement rate for any hospital shall be made for the income or profits realized by that hospital from any investments and assets not associated with patient care, up to the full dollar value of such income or profits and taking into account a reasonable allowance for capital costs related to such investments or assets.
(b) Not later than the first day of January, one thousand nine hundred ninety-five, the authority shall develop a system of payment for noninstitutional health care providers, based on a resource based relative value scale. The proposal shall be submitted in the form of specific legislation for consideration by the Legislature during the subsequent legislative session, which proposal shall include in the same legislation recommendations for changes to the tort and liability system as it relates to malpractice suits against health care providers.
(c) Not later than the first day of January, one thousand nine hundred and ninety-five, the authority shall propose a method to regulate the rate of profit or rate of loss realized by investors in health care-related equipment and facilities not subject to rate-setting under subsection (a) or (b) of this subsection. Such proposal shall be submitted in the form of specific legislation for consideration by the Legislature during the next regular legislative session.
(d) Not later than the first day of January, one thousand nine hundred ninety-seven the authority shall submit to the governor and the Legislature a plan for establishing and implementing a system of prepaid, prospective payment for the delivery of all health care services included in the uniform health benefits package. Such plan shall be in the form of specific legislation to be considered by the Legislature during the subsequent legislative session.
(e) The rate-setting methodologies and plan for prepayment hereinabove provided shall be coordinated to the extent possible with any federal prospective payment system or other reforms, and the authority shall revise its rules pursuant to the provisions of chapter twenty-nine-a of this code, or shall present to the governor and Legislature legislation required, to comply with such federal reforms.
(f) As soon as possible, in relationship to federal health care financing reforms, the authority shall develop and submit to the governor and Legislature a mechanism for recapturing any savings in the state's health care system and applying such savings to finance universal coverage for health care services defined in the uniform health benefits package.
(g) In establishing any proposal or rules under this section, the authority shall consider the availability of health care services throughout West Virginia, the cost of health care services throughout West Virginia, the specific groups of patients to whom such rate-setting shall apply, the circumstances, if any, under which balance billing shall be allowed, the financial relation between West Virginia health care providers and out-of-state patients and insurers, and the financial relation between West Virginia patients and out-of-state providers of health care services.
(h) It is further anticipated that such proposals shall be submitted in a timely manner and in the designated sequence with other health care proposals and reports required by this chapter.
(i) The authority shall forward in a timely manner to the public employees insurance agency finance board the diagnostic related group payment guidelines developed pursuant to subsection (a) of this section, the resource based relative value scale developed pursuant to subsection (b) of this section and the prospective payment methodologies developed pursuant to subsection (d) of this section. The public employees insurance agency finance board shall adopt these guidelines in establishing maximum reimbursement levels for medical providers as authorized in section five, article sixteen, chapter five of this code. Notwithstanding any other section of this code to the contrary, the public employees insurance agency finance board shall retain the sole authority to establish a health care benefit package for participating employees and until the first day of July, one thousand nine hundred ninety-nine, the sole authority to establish the maximum rates for reimbursement to medical providers. After the first day of July, one thousand nine hundred ninety-nine, the health care authority may require the public employee insurance agency finance board to adopt the same actual rates for diagnostic related group as implemented by the state health care cost review authority, and the resource based relative value scale and the prospective payment system as may be adopted by the Legislature: Provided, That the annual report of the authority beginning in the year one thousand nine hundred ninety-six shall include a report of the differences between the maximum payment schedule to providers established by the public employees insurance agency finance board and the rates implemented by the state health care cost review authority.
 § 16A-1-10. Management of state health programs.
(a) The following cost containment strategies must be implemented by state health programs:
(1) Medicaid, the public employees insurance agency 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: Provided, That to insure that there is no increase in total state behavioral health expenditures in implementing the provisions of this subdivision, the secretary of the department of health and human resources shall transfer to the managed care system those funds for community-based and institutional behavioral health services that can be more cost-effectively utilized as part of a managed care system and shall, on or before the first day of July, one thousand nine hundred ninety-five, report to the joint committee on government and finance and to the governor the fiscal impact on overall behavioral health spending and the quality of care of implementing the provisions of this subsection; and
(ii) Submit to the federal government necessary waiver requests to implement a capitated managed care demonstration project for families and the elderly.
(3) The public employees insurance agency 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, the public employees insurance agency, 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.
 § 16A-1-11. Uniform health benefits package.
(a) In furtherance of achieving the goal of providing universal coverage under a uniform health benefits package, as intended by this chapter, the authority shall define a uniform health benefits package for the citizens of West Virginia not later than the first day of December, one thousand nine hundred ninety-four. The uniform health benefits package shall include, but not be limited to, child health care, pregnancy-related care, behavioral health services, emergency care, preventive and primary care, and identified secondary and tertiary care including hospitalization. In developing the uniform health benefits package, the authority shall consider the following:
(1) Preventive care, including health promotion and primary care as priorities.
(2) Return to function as a key consideration for secondary and tertiary care.
(3) Basing decisions about providing health care services on individual needs, considering the effectiveness of treatment, quality of life and long-term benefits.
(4) Offering benefits within the context of a system requiring care management by primary care providers, which system defines rights to change care managers or opt out of care management systems, and considers incentives for care management systems including:
(i) quality of care and financial incentives, including but not limited to reduced deductibles, copayments, or insurance premiums, for persons covered under the uniform health benefits package participating in care management systems; and
(ii) incentives for primary care providers providing care management services, including but not limited to care management fees, cost control bonus fees, or higher rates of reimbursement.
(5) The extent to which optional coverages, deductibles, copayments, preauthorization, medical savings account options, referral by primary care providers, or other prerequisites for coverage are required or recommended.
(6) The cost of coverage.
(b) The authority shall also determine, within the limit of funds available, which health care services shall be available on a community level, within the defined geographic area of any health care network, whether experimental or permanent, on a regional level or a state-wide level.
(c) The authority may revise the state's uniform health benefits package from time to time, and shall conform with applicable federal health care requirements.
(d) Not later than the first day of January, one thousand nine hundred ninety-five, the authority shall perform a study to determine the best methodology to eliminate the denial of health insurance coverage due to preexisting medical conditions, which methodolology shall be recommended in the form of specific legislation for consideration by the Legislature during the next regular legislative session. This study shall include, but not be limited to, an examination of guaranteed-issue policies, high-risk pools in which all insurance carriers doing business in West Virginia would be required to participate, the effects on premium rates of eliminating denial for preexisting medical conditions, the effect on current cost shifting within the health insurance carrier marketplace, and the effect of any decreased burden on state-financed health plans which might result. In addition, the study shall take into account the potential for future legislation to mandate insurance coverage.
(e) Compliance with the uniform benefits plan may be phased in over time, within the limit of funds available.
 § 16A-1-12. Expansion of coverage.
(a) It is the intent of the legislature that steps be taken to expand coverage to children and the terminally ill and to pay for this coverage by maximizing federal funds. To achieve this intention, the department of health and human resources shall undertake the following:
(1) Effective the first day of July, one thousand nine hundred ninety-four, the department shall initiate a streamlined application form, which shall be no longer than two pages, for all families applying only for medicaid coverage for children.
(2) Effective the first day of July, one thousand nine hundred ninety-four, the department shall initiate the medicaid option to expand coverage of medicaid to all West Virginia children whose family's income is below one hundred fifty percent of the federal poverty level.
(3) Effective the first day of July, one thousand nine hundred ninety-four, the department shall initiate the option of hospice care to terminally ill West Virginian who otherwise qualify for medicaid.
(4) Effective no later than the first day of July, one thousand nine hundred ninety-four, the department shall initiate a single case management system for the medicaid waiver population. The system shall eliminate all duplication of case management in every county of this state and provide for the immediate transition of the terminally ill from the waiver program into the hospice care option.
(b) On the first day of January, one thousand nine hundred ninety-five and annually thereafter, the authority shall report to the governor and to the legislature information regarding the number of children and elderly covered by the program, specifically in subdivisions two and three, subsection (a) of this section, the cost of services by type of service provided, a cost-benefit analysis of the expansion on other insurers and the reduction of uncompensated care in hospitals as a result of expansion.
(c) The health care cost review authority established by section five, article twenty-nine-b of this chapter shall consider in its rate review that uncompensated care and charity care are reduced by this expansion and shall take the reduction into account when determining rates. This determination shall be undertaken in each hospital's next rate review and shall be determined prospectively.
(d) On the first day of January, one thousand nine hundred ninety-five, and annually thereafter, the authority shall present to the governor and to the legislature a report concerning the reduction in cost shift created by the operation of this article's provisions and shall identify and recommend any additional medicaid expansions which would further reduce cost shifting of the uninsured to other payors.
(e) Notwithstanding the provisions of section two-a, article four-a, chapter nine of this code, funds from the medical services trust fund may be utilized to pay for the expansion specified in subdivisions two and three, subsection (a) of this section.
§ 16A-1-13. 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-3-14. Demonstration projects for health care networks; criteria; direction by coordinating body.
(a) Not later than the first day of January, one thousand nine hundred ninety-five, the authority may develop and report to the Legislature a program for three demonstration projects for health care networks in defined geographic areas of the state. The networks shall be defined as cooperative and collaborative approaches to the delivery of health care services and shall include managed care concepts and provisions for cost containment and quality assurance. The networks shall provide preventive and primary care and may differ in plan or design. The authority shall participate in the planning process; invite participation by citizens within the geographic area served, health care providers and payors; and approve the design of each project. In planning and approving each demonstration project the authority shall consider the following:
(1) Flexibility in design and approach to meet the needs of the local community;
(2) Coordinated and cooperative health planning;
(3) Operation by health care providers and direction by a coordinating body as described in subsection (b) of this section;
(4) Participation by health care providers within the community, including both institutional providers and private practitioners and other noninstitutional providers;
(5) The uniform health benefits package defined pursuant to section eleven, article one of this chapter;
(6) Care management for each individual in the health care network, provided by primary care providers at the community level, and service coordination when appropriate;
(7) Delivery of health care services by a provider team within the parameters of the state health plan and consistent with other authority rules and policies;
(8) Quality assurance and utilization review consistent with the state health plan and other authority rules and policies;
(9) Within the limit of funds available, access to health care services provided through the health care network by all citizens within the geographic area defined;
(10) A system to ensure accountability for the appropriate use of limited resources and containment of costs consistent with the state health plan and other authority rules and policies;
(11) A single automated patient health care record;
(12) Shared communications systems; and
(13) Opportunity for all providers within the defined geographic area to participate in the project.
(b) Each demonstration project shall be directed by a coordinating body. The coordinating body shall be representative of the consumers of health care services, employers and other purchasers of health care services and the diverse health care providers within the community, including institutional providers, private practitioners and other noninstitutional providers, including local government and public health, all of whom shall be residents of the area served or to be served by the health care network. The coordinating body shall identify goals for the health care network and assess the needs of the area served or to be served by the alternative delivery system and may take such other actions authorized or required by the provisions of the implementation plan for the establishment of a health care network approved by the authority. The coordinating body shall ensure that the implementation plan approved by the authority is followed and that the health care network, when established, accomplishes its goals and fulfills the purposes for which it was established. The coordinating body may not be a for-profit entity. The members of a coordinating body may not receive any compensation other than payment of expenses for serving on the coordinating body.
(c) Not later than the first day of December, one thousand nine hundred ninety-six, the authority shall evaluate the progress of the demonstration projects and report on its evaluation, together with recommendations for future actions, if any, to the governor and the Legislature. The report shall include a cost-benefit analysis of any incentives offered pursuant to section fourteen of this article.
(d) The authority shall promulgate pursuant to the provisions of chapter twenty-nine-a of this code such rules as are necessary to implement the demonstration projects provided for in this article. Emergency rules for this purpose are specifically authorized.
§ 16A-1-15. Incentives for health care networks; rules; federal waivers; proposals for legislation.

The ultimate goal for health care networks is to provide universal coverage for the citizens of West Virginia under a uniform health benefits package at a reasonable, affordable cost: Provided, That nothing in this section shall be construed to require the utilization or appropriation of any state funds to accomplish the goals set forth in this section. The focus of health care networks is maintaining the health of the citizens within the defined geographic area of the state served by the health care network and providing incentives for the most appropriate and efficient way of addressing their health care needs. Therefore, the authority may establish start-up incentives for the establishment of demonstration projects for health care networks, and shall consider options including but not limited to preferential reimbursement for providers participating in the health care networks, decreased deductibles and copayments for consumers participating in the health care networks, and reimbursement rates reflecting the priorities of preventive and primary health care. The authority is hereby authorized to promulgate pursuant to the provisions of chapter twenty-nine-a of this code, not later than the first day of July, one thousand nine hundred ninety-five, rules providing or permitting incentives for health care providers to participate in the health care networks and for consumers to use the services provided by health care networks: Provided, That to the extent that such incentives are not permitted pursuant to the provisions of article sixteen, chapter five; chapter twenty-three; chapter thirty-three; or other provision of this code, the authority shall recommend to the governor and Legislature, not later than the first day of January, one thousand nine hundred ninety five, legislation providing or permitting such incentives. In the case of incentives requiring waivers, exemptions or preemptions or such other requests for changes in the manner of federal health care expenditures laws, rules or regulations, the authority shall submit applications or requests therefor: Provided, That the single state agency for medicaid in this state shall submit on a timely basis such applications or requests with respect to the state's medicaid program.

§ 16A-1-16. Technical assistance; grants for demonstration projects.

(a) The authority is hereby authorized and directed, upon specific appropriation which may be made by the Legislature or within the limits of other funds available, to provide technical assistance for expanding and supporting existing community health centers, to work with private practitioners in forming rural health clinics or federally qualified health centers, to assist and support public health departments in expanding their services to offer comprehensive primary care services, to assist communities in recruiting primary care practitioners to areas designated as underserved by the state, to assist and support small rural hospitals in developing primary care services and to assist providers in establishing outreach programs to underserved communities.

(b) The authority may provide grant money for all or any part of the demonstration projects for health care networks authorized by this article, either with funds which may be appropriated to it by the Legislature or through federal, private or other grant funds, or both.
 § 16A-1-17. 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-1-18. 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-1-19. Wellness.
(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 appoint a special assistant for wellness on or before the first day of September, one thousand nine hundred ninety-four. The special assistant shall have the primary responsibility to advise the authority on matters of health promotion and wellness. The special assistant shall be a person who has extensive experience in the promotion of wellness. The special assistant shall meet with the authority as necessary, but not less frequently than once per month.
(c) The authority shall, upon specific appropriation which ay be made by the Legislature or within the limits of other available funds, develop or cause to be developed, not later than the first day of November, one thousand nine hundred ninety-four, and implement not later than the first day of November, 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, if developed, among other measures, shall encourage people to:
(1) Establish a relationship with a primary care provider prior to the onset of illness;
(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.
(d) The authority shall coordinate existing programs of the office of health promotion in the bureau of public health, and of the public employees insurance agency.
(e) The authority shall coordinate with the deans of the schools of health sciences to develop wellness centers whose purpose and goal is the development of volunteer wellness initiatives.
(f) The authority, in cooperation with the bureau of public health, may upon specific appropriation which may be made by the Legislature or within the limits of other funds which may be available, implement a program to expand access to immunization for hepatitis-b and other blood borne pathogens, including, but not limited to, immunizations for the firefighters, including volunteer firefighters: Provided, That the program shall seek to obtain, at no cost or the lowest cost available, administration of the vaccinations from a licensed health care provider. Local health departments shall be notified of each immunization for hepatitis-b and other blood borne pathogens received by members of volunteer organizations within the service area of the local department of health and not subject to federal Occupational Safety and Health Act regulations. Local departments of health shall maintain, for a period of not less than thirty years, a record of the date of the immunization and the name of each firefighter within the service area of the local health department immunized against hepatitis-b and other blood borne pathogens.
§ 16A-1-20. Exemptions from collection of judgment; homestead protection; pensions.

(a) Any individual health care practitioner having available coverage against liability for malpractice of not less than one million dollars per occurrence and not less than three million dollars in the annual aggregate shall be entitled to the exemptions created in this section which limit the collection of any judgment or other order resulting from a claim of malpractice against that provider: Provided, That nothing in this section shall be construed to limit or prevent the collection of any judgment, claim or lien arising out of any action other than a malpractice action against a participating provider: Provided, however, That when the policy of insurance contains a clause requiring the consent of the insured for settlement, and the insured has refused consent to a bona fide offer to settle the claim within applicable policy limits, the exemption provided for in this section is deemed waived: Provided further, That upon the creation of the excess liability fund contemplated in section twenty-two of this article, participation in the excess liability fund to be created is required in order to retain entitlement to the exemptions created in this section. As used in this section "available coverage" means coverage against liability for malpractice available at the time a claim is made and against which no previous claim has been either asserted or satisfied. Upon notice or knowledge of any claim for malpractice, an individual provider having coverage against liability for malpractice of one million dollars per occurrence and three million dollars in the annual aggregate must buy back additional coverage for the lesser of (1) the amount of the claim or (2) one million dollars in order to retain entitlement to the exemptions created in this section with respect to any subsequent or additional claims: Provided, That persons whose insurance coverage is provided through the state of West Virginia or through a program administered by the state of West Virginia who are the subject of a claim of medical malpractice are eligible for the exemptions provided in this section notwithstanding any other provision of this subsection.

(b) In addition to the homestead exemption provided by section forty-eight, article six of the Constitution of the state of West Virginia, any individual practitioner maintaining coverage as set forth in subsection (a) of this section shall be entitled to a homestead exemption in the amount of the value of any real estate and improvements thereon used as a primary residence by the practitioner or his or her family: Provided, That any individual participating practitioner electing this exemption must designate the property exempted and must make the designation in an instrument that is signed, acknowledged and recorded in the office of the clerk of the county commissioner of the county in which all or part of the property is located. The county clerk shall record the designation in the county deed records. The designation must contain a description sufficient to identify the property designated, a deed book reference and a statement by the person or persons who executed the instrument that the property is designated a protected homestead under this section: Provided, however, That if an execution resulting from a judgment rendered as a result of medical malpractice is issued against an individual participating practitioner who has not made a voluntary designation of the homestead exemption as provided under this section, the judgment creditor may give the practitioner notice to designate the residential homestead, if any, protected by this section within twenty days after the date of service of the notice to designate. If the individual participating practitioner fails to designate any property which could be protected by this section, the exemption shall be deemed waived.
(c) Any individual practitioner maintaining coverage as set forth in subsection (a) of this section shall be entitled to an exemption of the value of any public or private pension plan or plans held by the practitioner for the benefit of himself or herself or of his or her family. For purposes of this section, a pension is defined, to the extent not prohibited or limited by federal law, as the value of any interest in any private retirement pension or profit sharing plan and trust which qualifies as such under the applicable provisions of the United States internal revenue code, including individual retirement accounts, and any similar public employee's retirement pension or profit sharing plan, regardless of whether it is required to qualify as such under applicable provisions of the United States internal revenue code: Provided, That any individual participating practitioner electing the exemption provided by this subsection shall notify the entity with which such pension is maintained of such election, which notification shall be signed, acknowledge and delivered upon the issuance of any excess insurance coverage provided by this article and shall include proof of coverage as may be required by such managing entity: Provided, however, That the amount of the exemption set forth in this subsection is limited to the value of any public or private pension plan or plans held by the practitioner at the time of notice or knowledge of the claim of malpractice against the practitioner.
(d) Any individual participating practitioner who asserts the exemptions provided by this section falsely; or without obtaining the medical malpractice insurance required herein; or after cancellation or termination of the coverage; or in any effort to avoid collection of a judgment based on a claim other than medical malpractice shall be reported to the applicable governing board for his or her profession and shall be subject to suspension or revocation of professional licensure. Upon creation of the excess liability fund created in section twenty-two of this article, an individual participating practitioner falsely asserting such exemption shall have his or her excess policy immediately terminated and canceled.
 § 16A-1-21. 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. The 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 authority may request or task force may deem appropriate, or may have an impact on the availability, quality and affordability of health care services in the state. Not later than the first day of January, one thousand nine hundred ninety-five, the authority shall recommend to the governor and the Legislature a proposal in the form of specific legislation for consideration by the Legislature during the subsequent Legislative session for changes to the tort and liability system as it relates to malpractice suits against health care providers. The proposal shall include, in the same piece of legislation, a proposal for a system of payment for noninstitutional health care providers based on a resource based relative value scale. The authority may conduct one or more demonstration projects in connection with such task force and plan.
 § 16A-1-22. Excess liability fund.
(a) Not later than the first day of January, one thousand nine hundred ninety-five, the authority shall submit to the governor and the Legislature a plan to create an excess liability fund for health care provider malpractice.
(b) The authority shall consider the following in developing an excess liability fund plan:
(1) Whether economic and noneconomic losses recoverable from the fund should be limited and whether and to what extent, if any, punitive damages should be allowed;
(2) Who should bear the additional premium cost of the fund;
(3) Whether awards from the fund shall be in periodic installments or a lump sum;
(4) Whether participation in the fund shall be mandatory;
(5) What threshold of primary insurance coverage each participant in the fund shall have;
(6) Whether the threshold of primary insurance coverage shall be categorized by risk category or whether the premium paid for a uniform threshold shall be based upon the specialty risk category;
(7) Whether a participant provider shall have the option to self-insure for the threshold amount;
(8) Whether the premium paid for coverage by the fund shall be reduced if the provider has primary insurance coverage above the threshold amounts;
(9) Whether the fund shall operate on a claims-made or occurrence basis;
(10) Whether assets of the fund shall be protected from any other use;
(11) Whether lower premiums shall be used as incentives for providers to practice in rural areas or in primary care;
(12) Who shall manage the fund; and
(13) Whether providers covered by state insurance policies shall be allowed to continue with the basic coverage provided by the state before the fund is activated on claims made against them.
(c) Prior to submission of such plan, the authority shall contract for and conduct an actuarial study to determine the financial feasibility and cost effectiveness of such fund, including the amount of premiums required. Such financial information shall be included in the plan submitted to the governor and the Legislature.
 § 16A-1-23. Rural health recruitment strategies.
The authority shall undertake a study developing strategies to attract primary care providers to medically underserved areas of the state. The study shall be developed in consultation with representatives of each of the three medical schools. The study, together with a proposal for legislation implementing the strategy, shall be submitted to the governor and the Legislature not later than the first day of December, one thousand nine hundred ninety-five. In developing its plan, the authority shall consider the following initiatives:
(a) Development of a rural health residency program.-- The rural health residence program may include establishment of a special revolving account under the university of West Virginia board of trustees, to be known as the rural health residency fund, to be made available in loans to individuals who have been accepted for a family practice, general pediatrics, general internal medicine, or obstetrics/gynecology residency in allopathic or osteopathic medicine and who sign contracts to establish practice after residency in a medically underserved area of the state as determined by the authority, with the advice of the community and rural health advisory council and the bureau of public health. Each loan granted should be limited to five thousand dollars per year, except that at the end of the last year of residency an amount up to five thousand dollars for each year of loan participation, not to exceed a total of fifteen thousand dollars, may be granted for the purpose of establishing practices in medically underserved areas. The loan program may include provision for loan forgiveness for individuals submitting sworn statements of service to the board of trustees and also may include provision for stipends to residents participating in the program;
(b) Development of a rural practice fellowship program. -- The plan may include loans for the establishment of practices to West Virginia residents licensed within the previous five years to practice medicine in West Virginia, who have completed a residency program in allopathic or osteopathic medicine in family practice, obstetrics/gynecology, general internal medicine, or general pediatrics and who sign contracts to establish practices in medically underserved areas of the state as determined by the authority, with the advice of the community and rural health advisory council and the bureau of public health;
(c) Development of a plan for participants in the rural practice fellowship to teach in the residency program on a part-time basis as well as recommendations for compensation thereof. Nothing in any written agreement which may be entered into under the provisions of this section shall affect the terms of employment of the individual who shall negotiate, separate from the program, his or her salary and other forms of employment with an agency, institution or program in which he or she shall be employed; and
(d) Development of medical education recruitment initiatives. -- The initiatives to be developed shall include consideration of:
(i) A mechanism for giving priority admissions to individuals expressing an interest in family practice and other primary care specialties, including, for the purposes of this section, general pediatrics, general obstetrics-gynecology and general internal medicine, and to students with ties to the state of West Virginia and for ensuring that at least twenty percent of each entering class is filled with students from medically underserved areas of West Virginia who are interested in primary care practice, which mechanism may include excepting from consideration an applicant's grades from the first year of college;
(ii) A plan for actively recruiting students from rural and medically underserved areas of the state at the earliest possible time, including, but not limited to, high school;
(iii) A plan for enhancing the prestige of family practice and other primary care specialties;
(iv) A plan for providing opportunities for appropriate student interaction with primary care practitioners during the first, as well as the subsequent years of medical education, which plan shall include, but not be limited to, increased numbers of primary care faculty;
(v) Goals for increasing the numbers of family practitioners and other primary care providers in the state, particularly in medically underserved areas, which goals shall include, but not be limited to, increasing the percentage of medical students in the state choosing primary care to forty percent;
(vi) A plan to increase the prestige of teaching and clinical practice, which plan shall include, but not be limited to, within the limits of funds available, increased funding for teaching and clinical practice, so that clinical work is performed primarily for educational and service purposes, and a revised system for hiring, promotion and tenure where applicable that values teaching and clinical work at least as greatly as research. The plan may consider the option of eliminating tenure for faculty physicians should this option be viable and productive to the goals of the plan. Such plan shall have a proposed implementation date no later than the first of July, one thousand nine hundred ninety-six;
(vii) A plan for including family practice rotations comparable with other rotations;
(viii) A plan for incorporating provider teams involving residents and/or students from the various health care professions into all health profession education;
(ix) A plan for incorporating multidisciplinary experiences for each health professional student; and
(x) A plan for increasing the number of physical therapy students at the lowest possible additional cost.
(e) Other strategies for rural recruitment and retention to be developed in the plan may include:
(i) Recommendations to make West Virginia more competitive with other states in the recruitment and retention of physicians and reduce inequities that small or rural hospitals and small or rural communities have in the funding and recruitment of physician services;
(ii) Credits against the tax imposed by article twenty-one, chapter eleven of this code for periods not to exceed five years for primary care physicians establishing practices in medically underserved areas;
(iii) A plan for paying residents in the fields of family practice, general pediatrics, general obstetrics-gynecology and general internal medicine, respectively, competitive salaries and other benefits, equal to or greater than the salaries and other benefits offered for other residencies in such fields in the United States;
(iv) A plan for assisting communities in furnishing bonuses to residents who agree to practice in such communities upon the completion of their residencies and for directly furnishing bonuses to residents who agree to practice in medically underserved areas, and the establishment of a foundation for this purpose.
(d) The authority shall implement, not later than the first day of July, one thousand nine hundred ninety-four, a program entitled "Each One, Teach One." Guidelines for the program shall be developed by the vice chancellor for health sciences of the university system with the advice of the community and rural health advisory council. The program shall be designed to provide a physician in a community to act as a mentor, to provide input and participate in medical school admission of, and otherwise assist, including but not limited to by summer employment, a student through college, medical school and residency, with the requirement that the student locate in the community after residency training for not less than a designated period of time and, in turn, serve as a mentor. The vice chancellor shall recommend to the authority incentives for participation in the program.
§ 16A-1-24. Distribution of health care professionals; marketing initiatives.

The authority shall undertake a study of the distribution of health care professionals in the state, and shall develop a strategy for coordinating and implementing, through appropriate means, educational activities directed toward solving any distribution problems revealed in the study. The study, together with a proposal for legislation implementing the strategy, shall be submitted to the governor and the Legislature not later than the first day of December, one thousand nine hundred ninety-five. In developing its strategy, the authority shall consider the following initiatives:

(1) Development of an office of professional education preparation programs to coordinate, promote and support the marketing initiatives, under the advisement of the community and rural health advisory council;
(2) Identification of high school students and other individuals from designated medically underserved areas of the state who have indicated an interest in, and demonstrated potential for pursuing professional careers;
(3) Provision of special educational opportunities for such students to prepare themselves for admission to, and graduation from, professional schools;
(4) Provision of extramural (off-campus) educational opportunities for professional students in rural and other designated medically underserved areas of the state;
(5) Identification of currently enrolled professional students, postgraduate trainees and residents who are deemed to have realistic potential for recruitment to practice in medically underserved areas of the state;
(6) In conjunction with other state agencies, provision for the intensive recruitment of such students and postgraduate trainees for practice in medically underserved areas within the limit of funds available; and
(7) Liaison establishment and assistance to the state board of education in developing counseling and other related programs to encourage students from shortage areas to prepare for professional careers.
(8) The establishment and publication of admission criteria and approximate weight of each criteria including a criterion based upon permanent residence in underserved or underrepresented areas of the state, by every institution of higher education in the state offering professional health care education programs.
(9) Establishment of a summer program, similar to that operated as the Minnesota Rural Physicians Associate Program, for high school and college students interested in health care professions and for health care profession students with health care practitioners.
(10) Promotional presentations given by participants of the rural health scholars program established by section three, article three, chapter eighteen-c of this code, to high schools and colleges throughout the state, promoting health care professions.
§ 16A-1-25. School health.
The authority may work with the state department of education to further refine the strategy to implement the school health projects of the department of education and the school health committee, including identifying training requirements, determining sources and required amounts of funding, and establishing a time line for implementing comprehensive school health programs in grades kindergarten through twelfth in every school in the state not later than the academic year beginning in one thousand nine hundred ninety-seven: Provided, That any additional funding or personnel required, shall be funded outside the school aid formula and only made available by line item appropriation which may be made by the Legislature or through the expenditure of other available funds.
 § 16A-1-26. Comprehensive children's health services.
The authority shall work with the governor's cabinet on children and families and may, upon specific appropriation which may be made by the legislature or within the limit of other available funds, implement the comprehensive health services recommended in the report of the children's commission within the cabinet.
 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 consistent with the state health plan and other guidelines established by the health care authority.
 § 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 and the authority:
(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, any local health board shall coordinate its activities with regional public health networks to be established; 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, may create regional public health networks to facilitate the development of a model statewide public health system: Provided, That the structure of the public health system shall be consistent with the state health plan and other guidelines established by the health care authority. A regional public health network shall be a subdivision of the state and shall execute the public health policies of the health care authority, 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.
 § 16A-2-7. Community-based health promotion programs.
 (a) The authority may, upon specific appropriation which may be made by the Legislature or within the limit of other funds which may be available, develop or cause to be developed, not later than the first day of November, one thousand nine hundred ninety-four, a comprehensive, integrated plan that creates educational, organizational, political, economic and other environmental supports designed to facilitate actions and conditions of living conducive to health of all West Virginians. Such plan, if developed, shall consider the following:
(1) The establishment of incentive programs by the commissioner of the bureau of employment programs, under section four, article two, chapter twenty-three of this code for subscribing employers that have achieved appropriately recognized wellness awards as determined by the authority with input from the wellness council of West Virginia.
(2) The establishment of incentive programs by the public employees insurance agency finance board for insured employees, spouses and dependents who complete a wellness program under section eight, article sixteen, chapter five of this code.
(3) The expansion of the wellness council of West Virginia or other appropriate entities to include a school wellness and community wellness tract in addition to the existing worksite wellness tracts.
(4) The establishment of a West Virginia health corps to assist communities to address improving the quality of life and wellness. The health corps would be a coordinated, interdisciplinary team of health professionals whose mission is to provide health enhancement opportunities for the citizens of West Virginia. It would provide student and faculty expertise from health education, medicine, pharmacy, nursing, physical therapy, exercise physiology, medical technology, social work, nutrition, psychology and other academic disciplines.
(b) All state agencies may, upon specific appropriation which may be made by the Legislature or within the limit of other funds available, develop wellness plans in coordination with representative groups of their employees. Any written plans which may be developed dealing with the proposed and existing health promotional activities, structures and policies shall be submitted to the authority not later than the first day of January, one thousand nine hundred ninety-five. Each plan shall include, but not be limited to, employee assistance programs services.
(c) The authority shall encourage all West Virginia hospitals, health clinics, community health centers, mental health centers and health profession organizations to promote wellness in their communities by aggressively promoting wellness among their employees and members. Health agencies, institutions and associations shall assume responsibility for the health climate of the communities they serve.
(d) The authority shall require higher educational institutions for health professions to promote the health and wellness of their students as part of their educational mission, so that health professionals will serve as role models for healthful lifestyles for their future clients.
(e) The authority shall promote and support the creation and maintenance of organized community-based health promotion programs throughout the state.
(f) 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.
 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; disclosure of fees.
(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) Not later than the first day of September, one thousand nine hundred ninety-four, and on or before the first day of January of each year thereafter, on a form or in a manner to be determined by the authority, each licensed health care provider in the state other than a hospital who provides health care service to the public on a fee-for-service basis shall disclose to the authority for each service or procedure done by that provider more than five times during the previous calendar year: (1) the CPT code, (2) a short description of the service or procedure and (3) the maximum fee charged by the provider for the service or procedure. A copy of the disclosure document shall be made available at each business location of the provider to any patient or other member of the public. A notice that fee information is available shall be prominently posted in each business location. The failure of a provider to comply with this subsection is a violation for which each health licensing board under chapter thirty of this code shall impose a penalty not to exceed one thousand dollars. Notwithstanding the provisions of section three of this article, the authority shall compile the fee information so reported and may disseminate it to the public. The fees so reported shall be the maximum fee for each service which may be charged by that provider during the subsequent calendar year: Provided, That nothing in this section shall require a health provider to submit data relating to the provider's fees which are less than ten dollars.
(g) 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. 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) No medical provider who has custody of medical records may 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 medical 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 in an emergency situation;
(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 medical 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 medical 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 to an insurance company or to a defendant or the defendant's legal counsel, in connection with a potential or actual malpractice claim against a medical provider;
(7) Providing information requested by another medical provider of medical care for the sole purpose of treating the patient on whom the record is kept;
(8) Providing information to a third party payor, for billing and claims review purposes only;
(9) Providing information to a peer review organization or for utilization review purposes, including AIDS information notwithstanding the provisions of section three, article three-c, chapter sixteen of this code;
(10) Providing information to a nonprofit health service plan, a blue cross/blue shield plan or an insurer to coordinate benefit payments under more than one sickness and accident, dental, or hospital and medical insurance policy other than an individual policy; or
(11) 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.
(12) Providing information pursuant to subpoenas, court orders or other federal or state statutes, rules or regulations.
(d) Knowing breach of the confidentiality of any health care records by a medical provider or anyone who obtains access to personally identifiable health care information except as provided in this section, as otherwise provided by law, or unless done without malice to protect the welfare of the individual or the public interest, shall be a misdemeanor punishable by up to a fine of two thousand dollars.
CHAPTER 18. EDUCATION.

 ARTICLE 5. COUNTY BOARD OF EDUCATION.
§ 18 - 5 - 22. Medical and dental inspection; school nurses; specialized health procedures; establishment of council of school nurses.

County boards of education shall provide proper medical and dental inspections for all pupils attending the schools of their county and shall further have the authority to take any other action necessary to protect the pupils from infectious diseases, including the authority to require from all school personnel employed in their county, certificates of good health and of physical fitness.

Each county board of education shall employ full time at least one school nurse for every one thousand five hundred kindergarten through seventh grade pupils in net enrollment or major fraction thereof: Provided, That each county shall employ full time at least one school nurse: Provided, however, That a county board may contract with a public health department for services deemed equivalent to those required by this section in accordance with a plan to be approved by the state board: Provided further, That the state board shall promulgate rules and regulations requiring the employment of school nurses in excess of the number required by this section to ensure adequate provision of services to severely handicapped pupils.
Any person employed as a school nurse shall be a registered professional nurse properly licensed by the West Virginia board of examiners for registered professional nurses in accordance with article seven, chapter thirty of this code: Provided, That a four-year degree shall not be required for employment as a school nurse as long as the nurse is actively pursuing a baccalaureate degree in nursing.
Beginning with the school year one thousand nine hundred ninety--ninety-one, specialized health procedures that require the skill, knowledge and judgment of a licensed health professional, shall be performed only by school nurses, other licensed school health care providers as provided for in this section, or school employees who have been trained and retrained every two years and subject to the supervision and approval by school nurses. After assessing the health status of the individual student, a school nurse, in collaboration with the student's physician, parents and in some instances an individualized education program team, may delegate certain health care procedures to a school employee who shall be trained pursuant to this section, deemed competent, have consultation with, and be monitored or supervised by the school nurse: Provided, That nothing herein shall prohibit any school employee from providing specialized health procedures or any other prudent action to aid any person who is in acute physical distress or requires emergency assistance. For the purposes of this section "specialized health procedures" means, but is not limited to, catheterization, suctioning of tracheostomy, naso-gastric tube feeding or gastrostomy tube feeding; and "school employee" means teachers as defined in section one, article one of this chapter and aides as defined in section eight, article four-a, chapter eighteen-a of this code.
Any school employee who elects to undergo training or retraining to provide, in the manner specified herein, such specialized health care procedures and for whom such selection has been approved by both the principal and the county board, may receive additional pay at the discretion of the county board: Provided, That any training may be considered in lieu of required in-service training of such school employee and a school employee cannot be required to elect to undergo the training or retraining: Provided, however, That commencing with the first day of July, one thousand nine hundred eighty-nine, any newly employed school employee in the field of special education shall be required to undergo the training and retraining as provided for in this section.
Each county school nurse, as designated and defined by this section, shall perform a needs assessment. These nurses shall meet on the basis of the area served by their regional educational service agency, prepare recommendations and elect a representative to serve on the council of school nurses.
There shall be established a council of school nurses which shall be convened by the state board of education. This council shall prepare a procedural manual and shall provide recommendations regarding a training course to the director of the state department of health commissioner of the bureau of public health who shall consult with the state department of education. The state department of bureau of public health shall then have the authority to promulgate rules and regulations to implement the training and to create standards used by those performing specialized health procedures. The council shall meet every two years to review the certification and training program regarding school employees.
The state board of education shall work in conjunction with county boards to provide training and retraining every two years as recommended by the council of school nurses and implemented by the state department of health bureau of public health.
CHAPTER 18B. HIGHER EDUCATION.

ARTICLE 1. GOVERNANCE.

§ 18B - 1 - 8a. Higher education accountability; institutional and statewide report cards.

(a) The governing boards are directed to make information available to parents, students, faculty, staff, state policymakers and the general public on the quality and performance of public higher education. This information shall be consistent and comparable between and among the state institutions of higher education and, if applicable, comparable with information from peer institutions in the region and nation. The governing boards shall prepare forms for institutional and statewide report cards and shall by the thirtieth day of September, one thousand nine hundred ninety-one, promulgate reasonable and proper legislative rules subject to approval of the Legislature pursuant to the provisions of article three-a, chapter twenty-nine-a of this code. Such legislative rules shall provide the legislative oversight commission on education accountability with full and accurate information while minimizing the institutional burden of recordkeeping and reporting. Such legislative rules shall include uniform definitions for the various indicators of student and institutional performance and guidelines for the collection and reporting of data and the preparation, printing and distribution of report cards under this section. The report card forms shall provide for brief, concise reporting in nontechnical language of required information. Any technical or explanatory material which an institution or governing board wishes to include shall be contained in a separate appendix available to the general public upon request.

(b) The president or chief executive officer of each public college, university or community college shall prepare and submit annually all requested data to the appropriate governing board at such time as the governing board may establish. The governing boards shall prepare institutional report cards for institutions under their jurisdiction and systemwide report cards which shall include the information required in the following subdivisions: (1) For all undergraduate students and for all institutions having undergraduate programs, the institution shall report the following as available and applicable: Average scores of incoming freshmen and transfer students on the American college test (ACT) or scholastic aptitude test (SAT); percentage of incoming freshmen enrolled in developmental classes; student performance as measured by grade point average and/or appropriate testing measures; the graduation or completion rate as may be defined by federal law or regulation for the student body as a whole and separately for students at the institution who received athletically-related student aid categorized by sex and athletic program; the rate at which individuals who complete or graduate from the program of an institution pass applicable licensure or certification examinations required for employment in a particular vocation, trade or professional field; student mobility (transfers in, transfers out and withdrawals); number and percentage of student body receiving tuition fee waivers; and number, percentage and dollar value of tuition fee waivers categorized by whether such waiver is for athletic participation or is an academic waiver and by whether the recipient is a resident or nonresident of this state.
(2) For professional schools, defined for the purposes of this section as academic programs leading to professions in which licensing is normally required and for which an undergraduate degree is a general prerequisite, the institution shall report the following as available and applicable: Average scores of beginning students and transfer students on standardized entrance examinations; number and percentage of student body receiving tuition fee waivers; number, percentage and dollar value of tuition fee waivers categorized by whether the recipient is a resident or nonresident of this state; the number of degrees granted; the graduation or completion rate as may be defined by federal law or regulation for the student body as a whole; the rate at which individuals who complete or graduate from the program of an institution pass applicable licensure or certification examinations required for employment in the particular professional field; the total number of students in each program, including the percentage of those students who are state residents, the percentage of students who are nonresidents of the state, the percentage of students who are women, and the percentage of students who are minorities as the term is defined by federal law; and the ratio of expenditures per pupil directly attributable to students enrolled in the professional school as compared to expenditures per pupil calculated as to students enrolled in the institution as a whole.
(3) For graduate schools, defined for the purposes of this section as academic programs leading to advanced degrees (masters or doctorates of philosophy in fields for which bachelor's degree programs are available) and for which an undergraduate degree is a general prerequisite, the institution shall report the following as available and applicable: Average scores of beginning students and transfer students on standardized entrance examinations; number and percentage of student body receiving tuition fee waivers; number, percentage and dollar value of tuition fee waivers categorized by whether the recipient is a resident or nonresident of this state; the number of degrees granted; the graduation or completion rate as may be defined by federal law or regulation for the student body as a whole; the rate at which individuals who complete or graduate from the program of an institution pass applicable licensure or certification examinations required for employment; and the total number of students in each program, including the percentage of those students who are state residents, the percentage of students who are nonresidents of the state, the percentage of students who are women, and the percentage of students who are minorities as the term is defined by federal law.
(4) In addition to any and all information required by subdivision (2) of this subsection, each health sciences school shall assist the vice chancellor for health sciences in providing information for the institutional and statewide report cards, which shall include reports on the following:
(A)(i) The percentage of students in each class from a medically underserved area of the state, as determined by the health care authority created in section five, article one, chapter sixteen-a of this code;
(ii) the percentage of students in each class who have indicated an interest in practicing in each primary care specialty;
(iii) the percentage of students in each class who have indicated an interest in practicing in a medically underserved area, as described above;
(iv) the overlap among the individual students listed in subdivisions (i), (ii) and (iii);
(v) the activities of the rural health loan program prescribed by section one, article three, chapter eighteen-c of the code, the rural health scholars program prescribed by section three of said article, and any rural health residency program or rural practice fellowship program to be created; and
(vi) information on the salaries, tenure and promotion of primary care faculty and how such salaries, tenure and promotions compare to those of other specialties and research: Provided, That this data shall not include names or other identifying information for individuals and instead shall be provided as figures in the aggregate.
(B) Information on graduates, including, but not limited to, placement of interns and residents, retention rates in the state, retention rates in underserved areas as determined by the division of health health care authority, the percentage practicing in primary care in this state to be defined as family medicine, internal medicine, pediatrics and obstetrics/gynecology, and other information pertinent to health sciences education as it relates to health care delivery in this state such as recruitment programs to attract health care providers to West Virginia, which information shall be kept and updated annually for each graduate for the first five years following his or her graduation, with information about whether a sub-specialty within a primary care specialty was chosen; reasons obtained from graduate surveys as to why health care graduates are leaving West Virginia; programs developed to direct graduates into primary care practices and specialty shortage areas in this state; and ways in which the health sciences schools intend to assist in meeting the projected health care needs of this state, including specialty and sub-specialty health care professional needs and where such needs are expected to arise, as those needs are defined by the division of health or such other state agency as the division of health may deem appropriate;
(C) Contractual and financial arrangements between the health sciences schools and such nonprofit and for-profit entities receiving moneys from the health sciences schools that the board of trustees determines have a significant impact on the provision of health sciences education in this state, such report to state the entity, the amount of funds paid to such entity and what the payment is for;
(D) The roles and missions of the health sciences schools and evaluation of each school's performance in accordance with outcome measures developed to evaluate the attainment of the roles, missions and programs developed for each school;
(E) The annual audit of the expenditures of each health sciences school and any audit received by the board from such nonprofit and for-profit entities determined by the board of trustees to have a significant affiliation to any health sciences school;
(F) Findings regarding management and operation of the health sciences schools, such findings to be based on the annual audits and to include proposals for and barriers to improving efficiency and generating cost savings in health sciences education.
(G) The quality of health sciences education, including but not limited to a review of any accrediting agency's report on health sciences education at any state-funded health sciences school;
(H) The clinical health care services and programs offered or delivered by the health sciences schools, including, but not limited to, programs which use existing state facilities for the purposes of clinical rotations;
(I) Matters relating to the funding and budgeting of health sciences education in this state, including, but not limited to, ways in which such budget effectuates the roles and missions of the health sciences schools;
(J) The financing of health sciences education subsequent to an annual, comprehensive review thereof, which report shall include anticipated capital costs, projected operating expenses, and future growth and recommendations on the allocation of any state or other tax dedicated to the funding of health sciences education; and
(K) Such other administrative, budgetary, financial, educational and other concerns as the board of trustees may deem necessary or helpful in providing information about the health sciences schools pursuant to this subsection.
(5) For all public institutions of higher education in the state, the following indicators of institutional performance in comparison with the aggregate of all other institutions in the state, region and nation as applicable and to the extent comparison data are available: Student-faculty ratio by school; student-administrator ratio; faculty turnover by school; educational and general expenditure per full-time equivalent (FTE) student; expenditure by fund in graphic display; the academic rank and years of experience of the faculty and administrators at the institution; percentage minorities comprise of faculty and major administrative staff; percentage women comprise of faculty and major administrative staff; percentage of classes taught by adjunct or part-time faculty; statistics concerning the occurrence on campus during the most recent school year and during the preceding school years for which data are available of criminal offenses reported to campus security authorities or local police; and statistics concerning the number of arrests for crimes occurring on campus during the most recent school year and during the preceding school years for which data are available. (c) The statewide report card shall include the data for each institution for each separately listed applicable indicator and the aggregate of the data for all institutions under the jurisdiction of the board of trustees of the university of West Virginia and for all institutions under the jurisdiction of the board of directors of the state college system for each indicator.
(d) The statewide report cards shall be prepared using actual institutional, state, regional and national data as applicable and available indicating the present performance of the individual institutions and the state systems of higher education and shall also include goals and trends for the institutions and the higher education systems. Each governing board as part of its assessment of the individual institutions under its jurisdiction shall include the number and gross dollar amount of grants received for academic research for each institution and a succinct review of research projects including a brief description of each project and the numbers of faculty, graduate and undergraduate students involved in each project. In assessing progress toward meeting goals and in developing trend information, the governing boards shall review report card data in relation to previously adopted board goals, five-year plans, regional and national higher education trends and the resource allocation model.
The higher education central office staff under the direction of the senior administrator shall provide technical assistance to each institution and governing board in data collection and reporting and shall be responsible for assembling the statewide report card from information submitted by each governing board.
Each governing board shall prepare report card information in accordance with the guidelines set forth in this section. The statewide report card shall be presented at a regular board meeting of the appropriate governing board subject to applicable notice requirements.
The statewide report cards shall be completed and disseminated with copies to the legislative oversight commission on education accountability prior to the first day of December, one thousand nine hundred ninety-two, and each year thereafter. Statewide report cards shall be based upon information for the current school year or for the most recent school year for which such information is available, in which case such year shall be clearly footnoted.
The governing boards shall make copies of both the institutional and statewide report cards available to any individual requesting them.
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.
 ARTICLE 3C. HEALTH CARE AGENCY RULE MAKING.
 § 29A-3C-1. Definitions.
As used in this article:
(a) "Committee" means the legislative health care oversight committee created in section three of this article.
(b) "Authority" means the West Virginia health care authority, created in section five, article one, chapter sixteen-a of this code.
(c) "Health care agency" means any agency identified by rule of the Health Care Authority pursuant to subsection (b), section eight, article one chapter sixteen-a of this code.
§ 29A - 3C - 2. Rules to be promulgated in accordance with this article.

In addition to other rule-making requirements imposed by law and except to the extent specifically exempted by the provisions of this chapter or other applicable law, every rule and regulation of the authority and every rule of any health care agency relating to health care policies or programs (including any amendment of or rule to repeal any other rule) shall be promulgated by the authority and health care agencies in accordance with this article and shall be and remain effective only to the extent that it has been or is promulgated in accordance with this article.

 § 29A - 3C - 3. Legislative health care oversight committee.
Not later than the first day of June, one thousand nine hundred ninety-four, the president of the Senate and speaker of the House of Delegates of the West Virginia Legislature shall appoint a legislative oversight committee charged with immediate and ongoing oversight of the authority. This committee shall study, review and examine the work of the authority and its staff and monitor the development and implementation of health care reform in this state. The committee may review and make recommendations to the Legislature regarding any plan or policy proposed by the authority. The committee shall review all legislative rules of the authority, all rules of any health care agency relating to health care policies or programs, and such other rules as the committee deems appropriate.
The committee shall be composed of six members of the Senate appointed by the president and six members of the House of Delegates appointed by the speaker. At least one member from each house of the Legislature shall be a member of the minority party. In addition, the president of the Senate and the speaker of the House of Delegates shall be ex officio nonvoting members of the commission and shall designate the cochairmen. Members shall serve until their successors shall have been appointed as heretofore provided.
The committee shall meet in conjunction with regular interim meeting of the legislature and at such other times as may be approved by the joint committee on government and finance. Members of the committee shall be entitled to compensation and expenses as provided in article two-a, chapter four of this code. Funds necessary for the work of the committee shall be paid from joint appropriations to the Senate and House of Delegates as authorized by the joint committee on government and finance.
§ 29A-3C-4. Legislative health care oversight committee rule making procedures; duties of authority and health care agencies.

All procedures before the legislative health care oversight committee shall be conducted in the same manner as proceedings before the legislative rule making review committee created in section ten, article three of this chapter. The authority and health care agencies shall have all duties and responsibilities with respect to rules and shall promulgate rules and follow all procedures as set forth in said article three. The provisions of sections two through nine and eleven through sixteen of said article three are incorporated herein by reference, including powers and duties of the secretary of state with respect to rules, except that rule making functions with respect to rules relating to health care policies or programs are vested in the legislative health care oversight committee created in this article.

§ 29A - 3C - 5. Prior rules.
Any rule lawfully promulgated prior to the effective date of this chapter shall remain in full force and effect until:
(1) Such rule is expressly made ineffective by the provisions of this chapter; or
(2) Such rule should expire by reason of failure to refile the same as provided in section five of article two, or expires pursuant to its own terms and provisions lawfully made before the effective date of this section; or
(3) Such rule is repealed by the lawful act of the authority, in conformity with this chapter; or
(4) Such rule is invalidated by an act of the Legislature or the force and effect of another law.
CHAPTER 30. PROFESSIONS AND OCCUPATIONS.

ARTICLE 1. GENERAL PROVISIONS.

§ 30-1-1. Application of article.

Unless otherwise specially specifically provided, every board of examination or registration referred to in this chapter including the West Virginia board of health, shall conform to the requirements prescribed in the following sections of this article.

 § 30-1-3. Officers; bond of secretary.
Every such board shall elect annually from its members a president and a secretary who shall hold their offices for one year and until their successors are elected: Provided, That the state board of law examiners, the state board of examiners for nurses and the state board of dental examiners may each elect a secretary from outside its membership. Officers of health profession licensing boards enumerated in section fifteen of this article and those which may be hereinafter established by law shall be registered annually with the governor, the secretary of the department of administration, the legislative auditor and the secretary of state. The secretary of every such board shall execute a surety bond conditioned as required by law, which bond shall be approved by the attorney general as to form and by the auditor as to sufficiency, and, when so approved, shall be filed and recorded in the office of the secretary of state. The premium on said bond shall be regarded a proper and necessary of expense of the board.
 § 30-1-4a. Lay members of health profession boards.
Notwithstanding any provisions of this code to the contrary, the governor shall appoint at least one lay person to represent the interests of the public on every health profession licensing board enumerated in section fifteen of this article referred to in this chapter and those which may be hereinafter established by law. If the total number of members on any of such boards after the appointment of one such lay person is an even number, one additional lay person shall be appointed. Said lay members shall serve in addition to any other members otherwise provided for by law or regulation. Such lay members shall be of the age of eighteen years or over, of good moral character, and competent to represent and safeguard the interests of the public. The lay member is empowered to participate in and vote on all transactions and businesses of the board, committee or group to which he or she is appointed.
Any person whose addition to a board as a lay member under the provisions of this section results in the addition of an odd number of lay additions to the board, shall serve for a term ending in an odd-numbered year on the date in that year on which terms of the professional members expire; of such members first appointed, each shall serve for a term ending on such date in the year one thousand nine hundred seventy-nine, and the successor to each such person shall serve for a term equal in length to the terms of the other professional members of the board. Any person whose addition to a board as a lay member under the provisions of this section results in the addition of an even number of lay additions to the board, shall serve for a term ending in an even-numbered year on the date in that year on which terms of the professional members expire; of such members first appointed, each shall serve for a term ending on such date in the year one thousand nine hundred seventy-eight, and the successor to each such person shall serve for a term equal in length to the terms of the other professional members of the board.
§ 30-1-4b. Limitation on number of terms a health profession licensing board member may serve.

Notwithstanding any provision of this code to the contrary, no health profession licensing board member shall serve more than two consecutive terms on any health profession licensing board enumerated in section fifteen of this article or referred to in this chapter.

§ 30-1-5. Meetings; quorum; power to compel attendance of witnesses and to take testimony.

Every such board shall hold at least two meetings each year, at such times and places as it may prescribe by rule, for the examination of applicants who desire to practice their respective professions or occupations in this state, and for the transaction of such other business as may legally come before it. The board may hold such additional meetings as may be necessary, which shall be called by the secretary at the direction of the president or upon the written request of any three members. A majority of the members of the board shall constitute a quorum for the transaction of its business. The board shall have power to compel the attendance of witnesses and to take testimony and proof concerning any matter within its jurisdiction, and for such purposes the president and secretary of the board shall have the power to administer oaths. In addition, health profession licensing boards enumerated in section fifteen of this article shall have power to issue subpoenas, to conduct investigations and to hire an investigator.

§ 30-1-5a. Duty of health profession licensing boards to investigate and resolve complaints and to make application to circuit courts for restraining orders.

Every health profession licensing board enumerated in section fifteen of this article and those which may be hereinafter established by law has a duty to, and shall in a timely manner, investigate and resolve complaints made to it, and shall provide the public access to the disposition of complaints made to it in accordance with the provisions of chapter twenty-nine-b of this code. Every such board has a duty to report, and shall report in a timely manner, upon receiving notice thereof, violations of individual practice acts within this chapter by an individual to the health profession licensing board where such individual may be licensed. Every person licensed or registered by any health profession licensing board enumerated in section fifteen of this article and those which may be hereinafter established by law has a duty to report, and shall report in a timely manner, to the board which licenses or registers such person a known or observed violation of the practice act or the board's rules and regulations promulgated thereunder by any other person licensed by the same board. Law enforcement agencies and courts shall report in a timely manner to the appropriate board any violations of individual practice acts by any individual.

Whenever a health profession licensing board obtains information that a person subject to its authority has engaged in, is engaging in or is about to engage in any act which constitutes, or will constitute, a violation of the provisions of this chapter which are administered and enforced by such board, the board may make application to the circuit court for an order enjoining such acts, and upon a showing that such person has engaged, is engaging or is about to engage, in any such acts, an injunction, restraining order, or such other order as the court may deem appropriate may be entered by the court.
§ 30-1-6a. Application for health profession examinations, licensure or registration; examination fee; reexamination.

Notwithstanding any other provision in this chapter to the contrary, each health profession licensing board enumerated in section fifteen of this article and those which may be hereinafter established by law is hereby authorized to establish by rule a deadline for application for examination which shall be not less than ten nor more than ninety days prior to the date of the examination.

Notwithstanding any other provision in this chapter to the contrary, health profession licensing boards enumerated in section fifteen of this article and those which may be hereinafter established by law may set by rule fees relating to the licensing or registering of individuals, which fees shall be sufficient to enable the boards to carry out effectively their responsibilities of licensure or registration and discipline of individuals subject to their authority.
Notwithstanding any provision in this chapter to the contrary, no applicant who fails to pass an examination to the satisfaction of the governing health profession licensing board shall be entitled to reexamination without reapplication and payment of such examination fees determined by that board for such reexamination.
§ 30-1-6b. Continuing professional education as a requirement for relicensure or reregistry by heath profession licensing boards.

All health profession licensing boards enumerated in section fifteen of this article shall promulgate rules which require continuing professional education as a condition of relicensure or reregistry. These rules shall be promulgated no later than the first day of July, one thousand nine hundred ninety-five. At a minimum, each health profession licensing board's rules shall require continuing education as a condition of continued licensure or relicensure, shall specify the amount of continuing education required over a set period of time, and shall establish compliance reporting requirements.

§ 30-1-8. Denial, suspension or revocation of a license of registration; proceedings; effect of suspension or revocation; transcript; report; judicial review.

(a) Notwithstanding any other provision of law to the contrary, no certificate, license, registration or authority issued under the provisions of this chapter may be suspended or revoked without a prior hearing before the board or court issuing said certificate, license, registration or authority: Provided, that this subsection shall not apply in cases where a health profession licensing board enumerated in section fifteen of this article and those which may be hereinafter established by law is authorized to suspend or revoke a certificate, license, registration or authority prior to a hearing if the individual's continuation in practice constitutes an immediate danger to the public.

(b) In all proceedings before a board or court for the suspension or revocation of any certificate, license, registration or authority issued under the provisions of this chapter, a statement of the charges against the holder thereof and a notice of the time and place of hearing shall be served upon such person as a notice is served under section one, article two, chapter fifty-six of this code, at least thirty days prior to the hearing, and he or she may appear with witnesses and be heard in person, by counsel, or both. The board may take such oral or written proof, for or against the accused, as it may deem advisable. If upon such hearing the board finds that the charges are true, it may suspend or revoke the certificate, license, registration or authority, and such suspension or revocation shall take from the person all rights and privileges acquired thereby.
(c) Any person denied a license, certificate, registration or authority who believes such denial was in violation of this article or the article under which said license, certificate, registration or authority is authorized shall be entitled to a hearing on the action denying said license, certificate, registration or authority. Hearings under this subsection shall be in accordance with the provisions for hearings set forth in subsection (b).
(d) A stenographic report of each proceeding on the denial, suspension or revocation of a certificate, license, registration or authority shall be made at the expense of the board and a transcript thereof retained in its files. The board shall make a written report of its findings, which shall constitute part of the record.
(e) All proceedings under the provisions of this section shall be subject to review by the supreme court of appeals.
 § 30-1-10. Disposition of moneys; report to auditor.
The secretary of every such board shall receive and account for all moneys derived by virtue of the provisions of this chapter applicable to such board, and shall pay them into the state treasury monthly, on or before the tenth day of the month succeeding the month in which such moneys were received. He shall also, on the first day of January and July in each year, or within five days thereafter, certify to the state auditor a detailed statement of all such moneys received by him during the preceding six months. Moneys paid into the state treasury by each health profession licensing board enumerated in section fifteen of this article and those which may be hereinafter established by law shall be placed into separate special funds of the state treasury established for each board. Such funds shall be used exclusively by each board for purposes of administration and enforcement of its statute: Provided, That when any special fund of any such board accumulates in excess of two times the annual budget of that board or ten thousand dollars, whichever is greater, the amount in excess shall be transferred by the state treasurer to the state general revenue fund: Provided further, That any and all fines levied shall be deposited in the state treasury general revenue fund. The state auditor shall audit the financial records of each health profession licensing board enumerated in section fifteen of this article and those which may be hereinafter established by law annually, and shall report to each board and the Legislature as to the audit.
 § 30-1-11. Compensation of members; expenses.
Each member of every such board shall receive thirty-five dollars for each day actually spent in attending the sessions of the board, or of its committees, and in necessary travel, and shall be reimbursed for all actual and necessary expenses incurred in carrying out the provisions of this chapter applicable to such board. The secretary shall receive such salary as may be prescribed by the board, but in proceedings relative to the fixing of his salary the secretary shall have no vote. All authorized compensation and all expenses certified by the board as properly and necessarily incurred in the discharge of its duties shall be paid out of the state treasury, from funds appropriated for that purpose, on warrants of the state auditor issued on requisitions signed by the president and secretary of the board except that all authorized compensation and all expenses certified by health profession licensing boards enumerated in section fifteen of this article and those which may be hereinafter established by law shall be paid out of the special fund established for each board by section ten of this article.
§ 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 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 those boards provided for in articles two-a three, four, five, six, seven, seven-a, eight, ten, fourteen, fourteen-a, fifteen, sixteen, seventeen, twenty, twenty-one, twenty-three, twenty-five, and twenty-six, twenty-eight, thirty, thirty-one, thirty-two and thirty-three of chapter thirty of this code. 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 may be within the office of the executive secretary of the health profession licensing boards. The secretaries of each of the health profession licensing boards shall may 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 authority. The individual so appointed shall have as a minimum qualification a working knowledge of the licensing and disciplining of professionals. This knowledge shall be demonstrated by education, training and successful experience in the licensing and disciplining of professionals. The executive secretary shall keep a copy of the fiscal records and accounts of each of the boards. The executive secretary shall keep the director authority 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 policies and programs 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) All members of health profession licensing boards covered by this chapter shall enjoy immunity from individual civil liability while acting within the scope of their duties as board members.

(b) Any member of a health profession licensing board 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, registered nurses, or licensed practical nurses, who, pursuant to any rule promulgated by the applicable governing board for a health 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 health professional 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.
(c) In the event a claim or cause of action is asserted against a member of any health 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.
(d) Within thirty days of the dismissal, settlement, adjudication or other termination of any claim or cause of action asserted against any health 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.
(e) The health care authority established by section five, article one, 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.
(f) 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.
CHAPTER 33. INSURANCE.

 ARTICLE 2. INSURANCE COMMISSIONER.
§ 33-2-17. Authority of office of consumer advocacy; retroactive effect of authority prohibited.

(a) In addition to the authority established under the rules promulgated by the director, the office of consumer advocacy is authorized to:

(1) Institute, intervene in, or otherwise participate in, as an advocate for the public interest and the interests of insurance consumers, proceedings in state and federal courts, before administrative agencies, or before the health care cost review authority, concerning applications or proceedings before the health care cost review authority or the review of any act, failure to act, or order of the health care cost review authority;
(2) At the request of one or more policyholders, or whenever the public interest is served, to advocate the interests of those policyholders in proceedings arising out of any filing made with the insurance commissioner by any insurance company or relating to any complaint alleging an unfair or deceptive act or practice in the business of insurance;
(3) Institute, intervene in, or otherwise participate in, as an advocate for the public interest and the interests of insurance consumers, proceedings in state and federal courts, before administrative agencies, or before the insurance commissioner, concerning applications or proceedings before the commissioner or the review of any act, failure to act, or order of the insurance commissioner;
(4) Institute, intervene in, or otherwise participate in, as an advocate for the public interest and the interests of insurance consumers, proceedings before the health care authority created in section five, article one, chapter sixteen-a of this code;
(4)(5) Review and compile information, data and studies of the reasonable and customary rate schedules of health care providers and health insurers, for the purposes of reviewing, establishing, investigating, or supporting any policy regarding health care insurance rates;
(5)(6) Exercise all the same rights and powers regarding examination and cross-examination of witnesses, presentation of evidence, rights of appeal and other matters as any party in interest appearing before the insurance commissioner or the health care cost review authority;
(6)(7) Hire consultants, experts, lawyers, actuaries, economists, statisticians, accountants, clerks, stenographers, support staff, assistants, and other personnel necessary to carry out the provisions of this section and sections sixteen and eighteen of this article, which personnel shall be paid from special revenue funds appropriated for the use of the office;
(7)(8) Contract for the services of technically qualified persons in the area of insurance matters to assist in the preparation and presentation of matters before the courts, the insurance commissioner, administrative agencies, or the health care cost review authority, which persons shall be paid from special revenue funds appropriated for the use of the office;
(8)(9) Make recommendations to the Legislature concerning legislation to assist the office in the performance of its duties;
(9)(10) Communicate and exchange data and information with other federal or state agencies, divisions, departments, or officers, and with other interested parties including, but not limited to, health care providers, insurance companies, consumers or other interested parties; and
(10)(11) Perform other duties to effect the purposes of the office.
(b) The provisions of this section do not apply to any filing made by an insurance company, or act or order performed or issued by the commissioner, or complaint filed by a policyholder with the commissioner prior to the thirtieth day of June, one thousand nine hundred ninety-one. All proceedings and orders in connection with these prior matters shall be governed by the law in effect at the time of the filing, or performance or issuance of the act or order.
(c) The scope of authority granted under this section and section sixteen of this article is restricted to matters related to health care costs and health insurance policies, subscriber contracts issued by organizations under article twenty-four of this chapter, health care corporations under article twenty-five of this chapter, health maintenance organizations under article twenty-five-a of this chapter, contracts supplemental to health insurance policies, and other matters related to health insurance issues identified by rules of the commissioner promulgated under section one of this article and chapter twenty-nine-a of this code.
 ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.
§ 33-15-15. Insurance commissioner to establish minimum benefits and coverages for an individual policy design; basic policy benefits; exemptions; legislative rules; premiums; applicability.

(c) The following shall serve as a guide to the commissioner in the design of a basic policy issued pursuant to this article:

(1) Inpatient hospital care up to twenty days per year;
(2) Outpatient hospital care including, but not limited to, surgery and anesthesia, preadmission testing, radiation therapy and chemotherapy;
(3) Accident or emergency care through emergency room care and emergency admissions to a hospital;
(4) Physician office visits for primary, preventive, well, acute or sick care, up to four visits per year, and laboratory fees, surgery and anesthesia, diagnostic X rays, physician care in a hospital inpatient or outpatient setting;
(5) Prenatal care, including a minimum of one prenatal office visit per month during the first two trimesters of pregnancy, two office visits per month during the seventh and eighth months of pregnancy, and one office visit per week during the ninth month and until term. Coverage for each such visit shall include necessary appropriate screening, including history, physical examination, and such laboratory and diagnostic procedures as may be deemed appropriate by the physician based upon recognized medical criteria for the risk group of which the patient is a member. Coverage for each office visit shall also include such prenatal counseling as the physician deems appropriate;
(6) Obstetrical care, including physician's services, delivery room and other medically necessary hospital services; and
(7) X-ray and laboratory services in connection with mammograms or pap smears when performed for cancer screening or diagnostic purposes, at the direction of a physician, including, but not limited to, the following:
(A) Baseline or other recommended mammograms for women age thirty-five to thirty-nine, inclusive;
(B) Mammograms recommended or required for women age forty to forty-nine, inclusive, every two years or as needed;
(C) A mammogram every year for women age fifty and over; or
(D) A pap smear annually or more frequently based on the woman's physician's recommendation for women age eighteen or over. A basic policy issued pursuant to this article may apply to mammograms or pap smears the same deductibles or copayments as apply to other covered services.
(8) Medical and laboratory services in connection with annual checkups for prostate cancer in men age fifty and over.
(9) Child immunization services as described in section five, article three, chapter sixteen of this code. This coverage will cover all costs associated with immunization, including the cost of the vaccine, if incurred by the health care provider, and all costs of vaccine administration. These services shall be exempt from any deductible, per-visit charge and/or copayment provisions which may be in force in these policies or contracts. This section does not require that other health care services provided at the time of immunization be exempt from any deductible and/or copayment provisions.
§ 33-15-17. Child immunization services coverage.

All policies issued pursuant to this article shall cover the cost of child immunization services as described in section five, article three, chapter sixteen of this code, including the cost of the vaccine, if incurred by the health care provider, and all costs of vaccine administration. These services shall be exempt from any deductible, per-visit charge and/or copayment provisions which may be in force in these policies or contracts. This section does not require that other health care services provided at the time of immunization be exempt from any deductible and/or copayment provisions.

ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§ 33-16-12. Child immunization services coverage.

All policies issued pursuant to this article shall cover the cost of child immunization services as described in section five, article three, chapter sixteen of this code, including the cost of the vaccine, if incurred by the health care provider, and all costs of vaccine administration. These services shall be exempt from any deductible, per-visit charge and/or copayment provisions which may be in force in these policies or contracts. This section does not require that other health care services provided at the time of immunization be exempt from any deductible and/or copayment provisions.

ARTICLE 16A. GROUP HEALTH INSURANCE CONVERSION.

§ 33-16A-15. Child immunization services coverage.

All policies issued pursuant to this article shall cover the cost of child immunization services as described in section five, article three, chapter sixteen of this code, including the cost of the vaccine, if incurred by the health care provider, and all costs of vaccine administration. These services shall be exempt from any deductible, per-visit charge and/or copayment provisions which may be in force in these policies or contracts. This section does not require that other health care services provided at the time of immunization be exempt from any deductible and/or copayment provisions.

ARTICLE 16C. EMPLOYER GROUP ACCIDENT AND SICKNESS INSURANCE POLICIES.

§ 33-16C-3. Exemption from mandatory benefits and coverages; optional benefits and coverages; deductibles and copayments.

(a) Notwithstanding any other provision of this code to the contrary, any basic policy issued pursuant to this article shall be exempt from all statutorily and regulatorily mandated benefits and coverages except for the minimum benefits and coverages provided for in section four of this article.

(b) Nothing in this article shall preclude an insurer from offering any other benefit or coverage under a basic policy issued pursuant to this article, for an appropriate additional premium: Provided, That any additional benefit or coverage must first be approved by the insurance commissioner.
(c) A basic policy issued pursuant to this article may include deductibles, copayments and maximum benefits: Provided, That any additional benefit must first be approved by the insurance commissioner: Provided further, That child immunization services shall be exempt from any deductible, per-visit charge and/or copayment provisions which may be in force in these policies or contracts. This section does not exempt other health care services provided at the time of immunization from any deductible and/or copayment provisions.
§ 33-16C-4. Insurance commissioner to establish minimum benefits and coverages; basic policy benefits.

(a) The insurance commissioner shall establish minimum benefits which shall be included in every insurance policy issued pursuant to this article. The commissioner may accept bids on designs for such minimum plans and shall compile a final basic benefit plan for use by insurers within six months after the effective date of this article.

(b) The basic policy plan established by the insurance commissioner may include coverage for the services of medical physicians or surgeons, podiatrists, physician assistants, osteopathic physicians or surgeons, chiropractors, midwives, advanced nurse practitioners, or any other professional health care provider as deemed appropriate by the insurance commissioner.
(c) The following shall serve as a guide to the commissioner in the design of a basic policy issued pursuant to this article:
(1) Inpatient hospital care up to twenty days per year;
(2) Outpatient hospital care including, but not limited to, surgery and anesthesia, preadmission testing, radiation therapy and chemotherapy;
(3) Accident or emergency care through emergency room care and emergency admissions to a hospital;
(4) Physician office visits for primary, preventive, well, acute or sick care, up to four visits per year, and laboratory fees, surgery and anesthesia, diagnostic X-rays, physician care in a hospital inpatient or outpatient setting;
(5) Prenatal care, including a minimum of one prenatal office visit per month during the first two trimesters of pregnancy, two office visits per month during the seventh and eighth months of pregnancy, and one office visit per week during the ninth month and until term. Coverage for each such visit shall include necessary appropriate screening, including history, physical examination, and such laboratory and diagnostic procedures as may be deemed appropriate by the physician based upon recognized medical criteria for the risk group of which the patient is a member. Coverage for each office visit shall also include such prenatal counseling as the physician deems appropriate;
(6) Obstetrical care, including physician's services, delivery room and other medically necessary hospital services; and
(7) X-ray and laboratory services in connection with mammograms or pap smears when performed for cancer screening or diagnostic purposes, at the direction of a physician, including, but not limited to, the following:
(A) Baseline or other recommended mammograms for women age thirty-five to thirty-nine, inclusive;
(B) Mammograms recommended or required for women age forty to forty-nine, inclusive, every two years or as needed;
(C) A mammogram every year for women age fifty and over; or
(D) A pap smear annually or more frequently based on the woman's physician's recommendation for women age eighteen or over. A basic policy issued pursuant to this article may apply to mammograms or pap smears the same deductibles or copayments as apply to other covered services.
(8) Medical and laboratory services in connection with annual checkups for prostate cancer in men age fifty and over.
(9) Child immunization services as described in section five, article three, chapter sixteen of this code. This coverage will cover all costs associated with immunization, including the cost of the vaccine, if incurred by the health care provider, and all costs of vaccine administration, These services shall be exempt from any deductible, per-visit charge and/or copayment provisions which may be in force in these policies or contracts. This section does not require that other health care services provided at the time of immunization be exempt from any deductible and/or copayment provisions.
ARTICLE 16D. MARKETING AND RATE PRACTICES FOR SMALL EMPLOYER ACCIDENT AND SICKNESS INSURANCE POLICIES.

§ 33-16D-14. Child immunization services coverage.

All policies issued pursuant to this article shall cover the cost of child immunization services as described in section five, article three, chapter sixteen of this code, including the cost of the vaccine, if incurred by the health care provider, and all costs of vaccine administration. These services shall be exempt from any deductible, per-visit charge and/or copayment provisions which may be in force in these policies or contracts. This section does not require that other health care services provided at the time of immunization be exempt from any deductible and/or copayment provisions.

ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS AND HEALTH SERVICE CORPORATIONS.

§ 33 - 24 - 7d. Required provisions in contracts which include child immunization services in the terms of the contract.

Each contract made by the corporation with participating hospitals, physicians, and other health agencies which provide immunizations to children shall require that bills submitted to the corporation for child immunization services rendered under the terms of their contracts will set forth separately those charges for said services. Charges for other health care services provided during the same visit shall not be included in the charge for immunization services.

ARTICLE 25. HEALTH CARE CORPORATIONS.

§ 33-25-8a. Third party payment for child immunization services.

Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article shall, on or after the first day of July, one thousand nine hundred ninety-four, provide as benefits to all subscribers and members coverage for child immunization services as described in section five, article three, chapter sixteen of this code. This coverage will cover all costs associated with immunization, including the cost of the vaccine, if incurred by the health care provider, and all costs of vaccine administration, These services shall be exempt from any deductible, per-visit charge and/or copayment provisions which may be in force in these policies, provisions, plans, agreements or contracts. This section does not require that other health care services provided at the time of immunization be exempt from any deductible and/or copayment provisions.

ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.

§ 33-25A-8a. Third party payment for child immunization services.

Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, any entity regulated by this article shall, on or after the first day of July, one thousand nine hundred ninety-four, provide as benefits to all subscribers and members coverage for child immunization services as described in section five, article three, chapter sixteen of this code. This coverage will cover all costs associated with immunization, including the cost of the vaccine, if incurred by the health care provider, and all costs of vaccine administration, These services shall be exempt from any deductible, per-visit charge and/or copayment provisions which may be in force in these policies, provisions, plans, agreements or contracts. This section does not require that other health care services provided at the time of immunization be exempt from any deductible and/or copayment provisions.