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)
[Introduced January 24, 1996;
referred to the Committee on Health and Human Resources;
and then to the Committee on 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 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
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
§16-33A-1. Short title.
This article may be cited as the "Breast and Cervical Cancer
Diagnostic and Treatment Fund."
(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
(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
§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
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
(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
§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
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.