H. B. 4013
(By Delegate Walters)
[Introduced January 10, 1996; referred to the
Committee on Health and Human Resources then Finance.]
A BILL to amend chapter sixteen of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, by adding
thereto a new article, designated article two-i, relating to
the rural hospital deregulation act; definitions; intent;
duties of the division of health and human resources;
rule-making authority; advisory board; increase of midlevel
providers; prohibiting requirement of certificate of need;
and, authorizing lease of state owned buildings not on tax
Be it enacted by the Legislature of West Virginia:
That chapter sixteen of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, be amended by
adding thereto a new article, designated article two-i, to read
ARTICLE 2I. THE RURAL HOSPITAL DEREGULATION ACT.
§16-2I-1. Short title.
This article shall be known and may be cited as the "Rural
Hospital Deregulation Act."
§16-2I-2. Legislative findings and declaration of intent.
The Legislature hereby finds and declares as follows:
(a) That excessive regulation has had an adverse impact on
the stability of rural hospitals;
(b) That a need exists to strengthen and, in some cases
salvage, rural hospitals to ensure that adequate access to
services is provided to residents of rural areas as well as to
tourists and other travelers; and,
(c) That in order to adequately address the problems
encountered by rural hospitals, a comprehensive approach must be
The Legislature, therefore, declares its intent to improve
the stability of rural hospitals by exempting them from
unnecessary procedural, licensure, and bureaucratic restrictions.
For the purposes of this article, the following terms are
defined as follows:
(a) "Department" means the department of health and human
(b) "Secretary" means the secretary of the department of
health and human resources;
(c) "Rural hospital" means an acute care hospital existing
outside the incorporated limits of any municipality with more
than five thousand persons, which is no less than thirty-five
miles by road or highway from the nearest existing acute care
hospital located in an incorporated municipality of no less than
five thousand persons;
(d) "Medical shortage area" means a county, or other
substantial geographical area in which the nearest acute care
hospital is no less than thirty-five miles by road or highway
from the nearest existing acute care hospital;
(e) "Midlevel providers" means providers of medical services
who are not doctors of medicine or osteopathy who are fully
licensed and approved to practice, but who are registered nurses,
nurse-midwives, graduate medical students and medical residents.
§16-2I-4. Curative measures to be addressed by department health
and human resources.
(a) In order to decrease the regulatory burden that is
increasingly threatening the stability of rural hospitals in this
state, the secretary shall institute a program designed to
accomplish the following:
(1) Provide regulatory relief to rural hospitals, when
appropriate, through flexibility in staffing, space and physical
(2) Modify inpatient limitations for medicaid so as not to impose unreasonable financial and administrative burdens that
single out rural hospitals for application;
(3) Set reimbursement rates for outpatient services at a
level which provides incentives for rural hospitals to focus on
the provision of outpatient services and which reduces the
financial losses incurred by rural hospitals in providing those
(4) Seek necessary waivers from the federal health care
financing administration; and
(5) Implement regulatory changes to reduce the requirements
for the licensing of rural hospitals.
(b) The secretary is authorized to make rules to effectuate
his or her duties as set forth herein and to otherwise effectuate
the purposes of this article.
(c) The governor with the advice and consent of the Senate
president and the speaker of the House of Delegates shall appoint
an advisory board composed of three persons, two of which shall
be administrators of rural hospitals and one who shall be a
physician who practices in a rural hospital. The advisory board
shall assist the secretary in determining appropriate levels for
inpatient limitations and reimbursement rates. The advisory board
shall additionally assist the secretary in determining
appropriate waivers to seek from the federal health care
financing administration and in determining needed regulatory changes. The advisory board shall commence its activities on the
first day of July, one thousand nine hundred ninety-six and shall
continue to serve in an advisory capacity until the conclusion of
two years, at which time the board shall cease to exist.
§16-2I-5. Midlevel providers' services to be utilized where
(a) No licensing board may prohibit registered nurses from
performing services at any rural hospital as a physician
substitute in a medical shortage area.
(b) Nurse-midwives shall be permitted to deliver babies in
a medical shortage area. A rural hospital without a physician
performing obstetrics may not restrict a nurse-midwife from
admitting patients. Home deliveries may not be restricted in a
home delivery area.
(c) Graduate medical osteopathic students and medical and
osteopathic residents may provide health care at rural hospitals
in their respective specialties with the approval of their
respective supervising physicians.
§16-2I-6. Certificate of need not required; leasing of
(a) No certificate of need may be required for any reason
from any rural hospital in a medical shortage area.
(b) Any state-owned building, not listed on the land books
for tax purposes, suitable to the needs of any rural hospital or other duly licensed and authorized health care provider may be
leased at fair market value from the appropriate state office or
agency for use in providing medical, osteopathic and other health
care services by such rural hospital or other health care
NOTE: The purpose of this bill is to create the rural
hospital deregulation act. The bill seeks to ease regulatory
burdens on small rural hospitals while allowing them to utilize
midlevel health care providers' services, such as nurse-midwives,
nurses, medical and osteopathic graduate students and residents.
The bill also places duties on the Secretary of the Department of
Health and Human Resources to ease burdensome rules, modify
inpatient limitations for medicaid, and set reimbursement for
outpatient services. The bill also creates an Advisory Board to
assist the Secretary of Health and Human Resources in carrying
out the purposes of the article while also granting authorization
for rule making in order to carry out the purposes. Finally, the
bill authorizes rural hospitals to lease state buildings, not
listed on the land books for use.
This article is new; therefore, strike-throughs and
underscoring have been omitted.