Senate Bill No. 101
(By Senators Ross, Sharpe and Helmick)
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[Introduced January 19, 1996;referred to the Committee on
Health and Human Resources;and then to the Committee on
Finance.]
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A BILL to amend and reenact section nine, article two, chapter
nine of the code of West Virginia, one thousand nine hundred
thirty-one, as amended, relating to increasing the number of
individuals approved for the West Virginia medicaid program
for the aged and disabled.
Be it enacted by the Legislature of West Virginia:
That section nine, article two, chapter nine of the code of
West Virginia, one thousand nine hundred thirty-one, as amended,
be amended and reenacted to read as follows:
ARTICLE 2. DEPARTMENT OF HEALTH AND HUMAN RESOURCES, AND OFFICE
OF COMMISSIONER OF HUMAN SERVICES; POWERS, DUTIES
AND RESPONSIBILITIES GENERALLY.
§9-2-9. Secretary to develop medicaid monitoring and case
management.
(a) On or before the first day of January, one thousand nine
hundred ninety-four, the secretary of the department of health
and human resources shall:
(1) Develop a managed care system to monitor the services
provided by the medicaid program to individual clients;
(2) Develop an independent referral service, including the
review of individual cases for abuses of the program; and
(3) Develop a schedule for implementation of the managed
care and independent referral system. The managed care system
shall focus on, but not be limited to, the behavioral health and
mental health services.
(b) In addition thereto, and in accordance with applicable
federal medicaid laws, the secretary shall prepare
recommendations, to be submitted to the joint committee on
government and finance on or before the first day of January, one
thousand nine hundred ninety-four. In developing recommendations
the secretary shall consider as options the following:
(1) Review of medicaid services which are optional under
federal medicaid law and identification of services to be
retained, reduced or eliminated;
(2) The elimination, reduction or phase-out of: (i)
Services which are not generally available to West Virginia citizens not covered under the state's medicaid program; or (ii)
services which are not generally covered under group policies of
insurance made available to employees of employers within the
state;
(3) The elimination or reduction of services, or reduction
of provider reimbursement rates, for identified services of
marginal utility;
(4) Higher reimbursement rates for primary and preventive
care;
(5) Changes in fee structure, which may include a system of
prospective payments, and may include establishment of global
fees for identified services or diagnoses including maternity
care;
(6) Utilization caps for certain health care procedures;
(7) Restriction of coverage for cosmetic procedures;
(8) Identification of excessive use of certain health care
procedures by individuals and a policy to restrict excessive use;
(9) Identification of services which reduce the need for
more costly options for necessary care and retention or expansion
of those programs;
(10) Identification of services for which preauthorization
should be requirement for medicaid reimbursement;
(11) Recommendations relating to the development of a
demonstration project on long-term care, which demonstration
project may be limited to patients with alzheimer's disease;
(12) A policy concerning the department's procedures for
compliance, monitoring and inspection; and
(13) Such other options as may be developed.
(c) From the fiscal year one thousand nine hundred
ninety-seven -- ninety-eight onward, the secretary shall cause
the state medical program for the aged and disabled to apply for
approval from the federal government to increase the number of
individuals served in this waiver program to as many as
practicable but in no event less than four thousand.
(c) (d) The secretary shall utilize in-state health care
facilities for inpatient treatment when such facilities are
available. Prior authorization, consistent with applicable
federal law, shall be required for out-of-state inpatient
treatment.
(d) (e) The secretary shall report to the joint committee on
government and finance on the development and implementation of
medicaid programs that provide incentives to working persons.
The secretary shall consider: Subsidies for low income working
persons; individual or small employer buy-ins to the state medicaid fund; prospective payment systems for primary care
physicians in undeserved areas; and a system to improve
monitoring of collections, expenditures, service delivery and
utilization.
(e) (f) The secretary shall report quarterly to the joint
committee on government and finance regarding provider and
facility compliance with federal and state medicaid laws,
including, but not limited to, the following: The number of
inspections conducted during the previous quarter; description
of programs, services and facilities reviewed; findings; and
recommendations for corrections.
NOTE: The purpose of this bill is to increase the number of
individuals approved for the West Virginia Medicaid Program for
the Aged and Disabled.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.