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, Dugan, Anderson,

Wiedebusch, Jackson and Boley)

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[Introduced January 24, 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 chapter sixteen of the code of West Virginia, one thousand nine hundred thirty-one, as amended, by adding thereto a new article, designated article thirty-three-a, relating to creating the breast and cervical cancer diagnostic and treatment fund; composition of fund; definitions; administration of fund; members; duties; covered services; eligibility; application; and dispersement of funds.

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 thirty-three-a, to read as follows:
ARTICLE 33A. BREAST AND CERVICAL CANCER PREVENTION AND CONTROL ACT.
§16-33A-1. Short title.
This article may be cited as the "Breast and Cervical Cancer Diagnostic and Treatment Fund."
§16-33A-2. Definitions.
(1) "Fund" means the breast and cervical cancer diagnostic and treatment fund.
(2) "Center" means the Mary Babb Randolph cancer center/Betty Puskar breast care center or any authorized committee thereof.
(3) "Qualified applicant" means a female who meets the financial and medical eligibility guidelines of this article.
(4) "Provider" means a physician, hospital or medical provider currently licensed under the appropriate state licensure laws.
§16-33A-3. 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 Mary Babb Randolph cancer center/Betty Puskar breast care center of the Robert C. Byrd health sciences center or an authorized committee established by the center. Nothing in this article may be interpreted to mean that covered diagnostic and treatment services are required to be provided by the center.
§16-33A-4. Covered services.
The director of the center shall appoint a committee of four physicians to promulgate 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. Covered services include diagnostic and treatment services for breast or cervical cancer or a condition suggestive of cancer. An ancillary diagnostic study may be authorized only when it is determined by the center to be directly related to the confirmation of a diagnosis of cancer or is necessary for treatment planning;
(2) Setting a limitation on days of service covered by the fund. The center shall authorize the number of days for reimbursement 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.
§16-33A-5. Financial eligibility.
To be eligible for services under the fund, a patient's income must be at or below two hundred percent of the federal poverty level (FPL) in accordance with the current national poverty income guidelines. No patient who is covered by medical insurance, medicaid or medicare may be financially eligible.
§16-33A-6. Medical eligibility.
(a) A patient shall have a condition strongly suspicious of cancer which requires diagnostic services to confirm the preliminary diagnosis to be medically eligible for diagnostic authorization. The center may authorize only those services determined by the center to be medically necessary to confirm a preliminary diagnosis.
(b) A positive pathology report is required before treatment services may be authorized by the fund.
§16-33A-7. Application process.
The center shall develop authorization request forms and make the forms available to the provider upon request.
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.
§16-33A-8. Reimbursement process.
The fund is the payor of last resort. Payment for procedures shall be made at the current rate established by medicare.
A claim for authorized services rendered shall be processed in accordance with rules promulgated by the center.



NOTE: This bill would create the breast and cervical cancer diagnostic and treatment fund.

This article is new; therefore, strike-throughs and underscoring have been omitted.