SB124 SUB1
COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 124
(By Senators Miller, Macnaughtan, Kimble, Walker,
Bailey, Sharpe, Ross, Schoonover, Blatnik, Grubb,
Yoder, Minear, Helmick, Whitlow, Love, Oliverio, Bowman,
Manchin, Tomblin, Mr. President, Anderson,
Wiedebusch, Jackson and Boley)
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[Originating in the Committee on Health and Human Resources;
reported February 22, 1996.]
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A BILL to amend and reenact section two, article thirty-three,
chapter sixteen of the code of West Virginia, one thousand
nine hundred thirty-one, as amended; and to further amend
said article by adding thereto five new sections, designated
sections seven, eight, nine, ten and eleven, all relating to
creating the breast and cervical cancer diagnostic and
treatment fund; defining certain terms; composition of fund;
administration of fund; committee members; appointment;
duties; covered services; eligibility; application; and
dispersement of funds.
Be it enacted by the Legislature of West Virginia:
That section two, article thirty-three, chapter sixteen of
the code of West Virginia, one thousand nine hundred thirty-one,
as amended, be amended and reenacted; and that said article be
further amended by adding thereto five new sections, designated
sections seven, eight, nine, ten and eleven, all to read as follows:
ARTICLE 33. BREAST AND CERVICAL CANCER PREVENTION AND CONTROL
ACT.
§16-33-2. Definitions.
As used in this article:
(a) "Approved organization" means an organization approved
by the director to provide medical services under section four of
this article;
(b) "Bureau" means the bureau of public health of the
department of health and human resources, established pursuant to
the provisions of article one of this chapter;
(c) "Commissioner" means the commissioner of the bureau of
public health;
(d) "Department" means the department of health and human
resources;
(d) "Director" means the director of the division of health;
(e) "Fund" means the breast and cervical cancer diagnostic
and treatment fund;
(f) "Provider" means a physician, hospital or medical
provider currently licensed under the appropriate state licensure
laws;
(g) "Qualified applicant" means a person who meets the
financial and medical eligibility guidelines of this article; and
(h) "Unserved or underserved populations" means persons
having inadequate access and financial resources to obtain breast
and cervical cancer screening and detection services, including
persons who lack health insurance or whose health insurance coverage is inadequate.
§16-33-7.Establishment of breast and cervical cancer diagnostic
and treatment fund.
There is hereby established the breast and cervical cancer
diagnostic and treatment fund which shall provide financial
assistance for the medical care of indigent patients for
diagnostic and treatment services for breast and cervical cancer.
The fund shall be comprised of moneys appropriated to the
fund by the Legislature, allocated to the fund by the federal
government and all other sums designated for deposit in the fund
from any source, public or private.
The fund shall be administered by the bureau of public
health. Nothing in this article shall mean that covered
diagnostic and treatment services are required to be provided by
any health care provider, the bureau or the department nor paid
for from the moneys appropriated, allocated or deposited into the
fund.
§16-33-8.Administration of fund; committee; duties; covered
services.
The director shall appoint a committee of four physicians to
establish rules for the administration of the fund.
The committee shall include one physician whose specialty is
gynecological oncology, one physician whose specialty is surgery,
one physician whose specialty is radiology and one physician
whose specialty is pathology.
Responsibilities of the committee include, but are not
limited to, the following:
(1) Establishing a list of covered services approved for
payment through the fund, including (A) diagnostic and treatment
services for breast or cervical cancer or a condition suggestive
of cancer; and (B) ancillary diagnostic studies that may be
authorized for the confirmation of a diagnosis of cancer or are
necessary for treatment planning;
(2) Setting a limitation on days of service covered by the
fund based on the medical condition of the patient and the
procedure to be performed; and
(3) Reviewing requests and providing authorization for
payment of diagnostic or treatment services covered by the fund.
§16-33-9. Patient eligibility.
To be eligible for assistance in payment of services under
the fund, the following conditions shall be met:
(a) The patient is not eligible for nor covered by medical
insurance, medicaid or medicare; and
(b) The patient's income must be at or below two hundred
percent of the federal poverty level; and
(c) The patient has a condition clinically indicative of
cancer that requires diagnostic services to confirm the
preliminary diagnosis and only those services determined to be
medically necessary for that diagnostic confirmation may be
authorized by the committee for payment from the fund; or
(d) The patient has received diagnostic confirmation
through a positive pathology report and is requesting payment of
treatment services by the fund.
§16-33-10. Application process.
(a) The bureau shall develop authorization request forms and make the forms available to the provider upon request.
(b) An application for inpatient diagnostic services shall
be accompanied by a written, signed statement from the attending
physician which includes the medical basis for required inpatient
services and explains why the services may not be performed on an
outpatient basis.
§16-33-11. Reimbursement process.
(a) The fund is the payor of last resort. Payment for
procedures shall be made at the prevailing rate established by
medicare.
(b) A claim for authorized services rendered shall be
processed in accordance with the rules established by the bureau.