COMMITTEE SUBSTITUTE
FOR
COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 457
(By Senators Walker, Tomblin, Mr. President, Wooton, Fanning,
Hunter, Macnaughtan, Craigo, Oliverio, Sharpe, Dittmar, Bailey,
Bowman, Snyder, Kessler, Prezioso, Buckalew, Jackson, White,
Plymale, Anderson, McKenzie, Sprouse, Chafin, Ball, Ross,
Schoonover, Scott, Love, Helmick, Minear and Boley)
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[Originating in the Committee on Finance;
reported February 27, 1998.]
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A BILL to amend chapter five of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, by adding
thereto a new article, designated article sixteen-b; and to
amend and reenact section two-b, article four-a, chapter nine
of said code, all relating to expanding health insurance
coverage to children; defining terms; creating division;
requiring employment of director; establishing directors
powers and duties; requiring state plan and interagency cooperation; creating program board; establishing
qualifications, compensation and procedures governing board
members; setting forth purpose, powers and duties of board;
requiring financial plans; authorizing the execution of
contracts and the procedures governing their award; and
expanding medicaid coverage to certain eligible children.
Be it enacted by the Legislature of West Virginia:
That chapter five of the code of West Virginia, one thousand
nine hundred thirty-one, as amended, be amended by adding thereto
a new article, designated article sixteen-b; and that section two- b, article four-a, chapter nine of said code be amended and
reenacted, all to read as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,
SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD
OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS,
OFFICES, PROGRAMS, ETC.
ARTICLE 16B. WEST VIRGINIA CHILDREN'S HEALTH INSURANCE PROGRAM.
§5-16B-1. Expansion of health insurance coverage to children.
(a) It is the intent of the Legislature to expand health
insurance coverage to eligible children and to pay for this
coverage using state dollars to match federal funds. To achieve
this intention, the West Virginia children's health insurance
program is created.
(b) The design and administration of the program is subject to the provisions of the children's health insurance program created
by federal law under Title XXI of the Social Security Act of 1997.
(c) The program created in this article shall be available to
families of children subject to eligibility criteria to be
established in a state children's health insurance plan which shall
be developed pursuant to this article. Nothing in this article
creates an entitlement to coverage in any person or child and
nothing in this article may be construed to require any
appropriation of state general revenue funds for the payment of any
benefit provided for in this article.
(d) The board shall report initial statistical information on
the children's health insurance program to the legislative
oversight commission on health and human resources accountability.
The report shall include, but not be limited to, the number of
covered children, the number of children served, by age,
statistical profiles of the families served, health status
indicators of covered children, the average annual cost of coverage
per child and the total cost of all children served by provider
type.
§5-16B-2. Definitions.
As used in this article, unless the context clearly requires
a different meaning:
(a) "Board" means the children's health insurance program
board;
(b) "Director" means the director of the children's health
insurance program;
(c) "Division" means the division of children's health
insurance created under section three of this article;
(d) "Essential community health service provider" means a
health care provider that:
(1) Has historically served medically needy or medically
indigent patients and demonstrates a commitment to serve low-income
and medically indigent populations which make up a significant
portion of its patient population, or, in the case of a sole
community provider, serves medically indigent patients within its
medical capability; and
(2) Either waives service fees or charges fees based on a
sliding scale and does not restrict access or services because of
a client's financial limitations including, but not limited to,
community mental health centers, school health clinics, primary
care centers, pediatric health clinics or rural health clinics.
§5-16B-3. Division created; director to be employed; powers and
duties.
(a) There is hereby created the division of children's health
insurance within the bureau for medical services in the department
of health and human resources. A division director shall be
appointed by the governor, with the advice and consent of the
Senate, who is responsible for the implementation, administration and management of the children's health insurance program created
under this article pursuant to Title XXI of the Social Security Act
of 1997. The director shall have at least a bachelor's degree and
a minimum of three years experience in health insurance
administration.
(b) To the extent practicable, the work of the children's
health insurance program shall be accomplished through interagency
cooperation: Provided, That the director may hire any employees he
or she determines are necessary for the division's effective
operation. The director shall provide administrative support for
the work of the board and shall present recommendations and
alternatives for the design of a children's health insurance
program, the initial and annual plans, and other actions undertaken
by the board in furtherance of this article.
§5-16B-4. Preparation of state plan; interagency cooperation.
Upon the effective date of this article, the secretary of the
department of health and human resources shall make the staff of
the department available to the children's health insurance program
to prepare, at the direction of the children's health insurance
program board and in the name of the board, the state Title XXI
plan required by applicable federal law. The plan shall include
those descriptions, procedures and proposals for implementation
under this article and article four-a, chapter nine of this code,
that will serve to qualify the state's program for children's health insurance for approval by federal authorities.
§5-16B-5. Children's health insurance program board created;
qualifications and removal of members; quorum; compensation
and expenses.
(a) There is hereby created the West Virginia children's
health insurance program board, which will serve as an advisory
board to the division of children's health insurance programs. The
board shall consist of nine voting members and shall include the
secretary of the department of health and human resources or his or
her designee, the director of the public employees insurance
agency, the commissioner of insurance, the commissioner of the
bureau for public health and five citizen members appointed by the
governor, with the advice and consent of the Senate. A member of
the Senate, as appointed by the Senate president and a member of
the House of Delegates, appointed by the speaker of the House of
Delegates, shall serve as nonvoting members. Of the initial five
citizen members, three shall serve a term of two years and two
shall serve a term of four years. Thereafter, citizen members
shall serve terms of four years and may be reappointed to their
positions: Provided, That no member shall serve more than two
consecutive terms. At least one of the citizen members shall have
experience in the administration, design or marketing of group
benefit programs, at least one of the citizen members shall be a
certified public accountant and two of the citizen members shall be the parents or legal guardians of children covered under the
provisions of this article. No more than three citizen members may
be members of the same political party. No board member shall
represent or have a pecuniary interest in an entity reasonably
expected to compete for contracts under this article. Members of
the board shall assume the duties of the office immediately upon
appointment and shall hold an initial meeting not later than the
thirtieth day of June, one thousand nine hundred ninety-eight. No
member may be removed from office by the governor except for
official misconduct, gross immorality, incompetence, neglect of
duty or other specific responsibility imposed by this article.
Vacancies in the board shall be filled in the same manner as the
original appointment.
(b) The board shall elect a chairperson and shall meet at a
time and place specified by the call of the chairperson or upon the
written request to the chairperson by either two members of the
board or by the director. Notice of each meeting shall be given in
writing to each member by the chairperson at least three days in
advance of the meeting. Five voting members shall constitute a
quorum.
(c) For each day or portion of a day spent in the discharge of
duties pursuant to this article, the board shall pay each of its
citizen members the same compensation and expense reimbursement as
is paid to members of the Legislature for their interim duties.
§5-16B-6. Purpose, powers and duties of the board; initial
financial plan; financial plan for following year; and
annual financial plans.
(a) The purpose of the children's health insurance program
board created by this article is to bring fiscal stability to the
children's health insurance program through development of an
annual financial plan designed to meet the division's estimated
total financial requirements.
(b) All financial plans required by this section shall include
the design of a benefit plan or plans. All financial plans shall
establish:
(1) Maximum levels of reimbursement to categories of health
care providers;
(2) Any necessary cost containment measures for implementation
by the director; and
(3) The types and levels of cost to families of covered
children. To the extent compatible with simplicity of
administration, fiscal stability and other goals of the program
established in this article, the financial plans may provide for
different levels of costs based on ability to pay.
(c) During state fiscal year one thousand nine hundred ninety- nine, benefits under this program shall be made available to
children ages six through eighteen whose custodial parents or
guardians have an income equal to or less than one hundred fifty percent of the federal poverty level as determined according to
eligibility standards and other criteria approved by the board.
(d) The board shall establish a target date for implementation
of the children's health insurance program during the state fiscal
year one thousand nine hundred ninety-nine.
(e) The board shall afford interested and affected persons an
opportunity to offer comment on the plan at a public meeting of the
board and, in developing any proposed plan under this article,
shall solicit comments in writing from interested and affected
persons.
(f) The board shall review implementation of its initial or
current financial plan in light of actual experience and, with the
services of an actuary, shall prepare an annual financial plan for
fiscal year two thousand and each fiscal year thereafter. For each
fiscal year, the governor shall provide his or her estimate of
total available funding to the board no later than the first day of
July of the preceding fiscal year. After obtaining an actuary's
opinion and conducting one or more public hearings, the board shall
submit its financial plan to the governor and to the Legislature no
later than the first day of January preceding the fiscal year. The
financial plan for a fiscal year shall become effective and shall
be implemented by the director on the first day of July of such
fiscal year.
(g) The provisions of chapter twenty-nine-a of this code do not apply to the preparation, approval and implementation of the
financial plans required by this section.
(h) The board shall meet no less than once each quarter to
review implementation of its current financial plan and shall make
those modifications to the plan that are necessary to ensure its
fiscal stability and effectiveness of service: Provided, That the
board may not increase the types and levels of cost to families of
covered children during its quarterly review except in the event of
an emergency, nor may the board expand the population of children
to whom the program is made available except in its annual plan.
(i) For any fiscal year in which legislative appropriations
differ from the governor's estimate of general and special revenues
available to the agency, the board shall, within thirty days after
passage of the budget bill, make any modifications to the plan
necessary to ensure that the total financial requirements of the
division for the current fiscal year are met.
§5-16B-7. Authorization to execute contracts.
(a) Subject to the advice and consent of the board, the
director may execute any contracts and agreements necessary to
carry out the provisions of this article.
(b) The provisions of article three, chapter five-a of this
code, relating to the division of purchasing of the department of
finance and administration, shall not apply to any contracts for
health insurance coverage or professional health services authorized to be executed under the provisions of this article.
Before entering into a contract, the director shall invite bids
from all qualified entities; shall take into account the experience
of the offeror; may consider any cost savings, administrative
efficiency, or other benefit to be gained from existing contracts
for services, including the possible modification of the contract,
and the extent to which the offeror proposes to utilize essential
community health service providers. Before any offeror may be
selected to provide benefits or coverage under the plan, it shall
provide assurances of utilization of essential community health
service providers to the greatest extent practicable. In
evaluating these factors, the director may employ the services of
independent, professional consultants. The director shall then
award the contracts on a competitive basis.
(c) The director shall issue requests for proposals from
essential community health service providers for defined portions
of services under the children's health plan regionally or
statewide, and shall, to the greatest extent practicable, either
directly contract with, or require participating providers to,
contract with essential community health service providers to
provide the services under the plan.
(d) Subject to the advice and consent of the board, the
director may require an insurer to reinsure portions of any
contract entered into pursuant to the provisions of this article.
§5-16B-8. West Virginia children's health fund.
(a) There is hereby created in the state treasury a special
revolving fund to be known as the "West Virginia children's health
fund", which shall be an interest-bearing account established and
maintained to purchase health services for low-income children.
All moneys deposited or accrued in this fund shall be used
exclusively:
(1) To provide the state's share of the federal children's
health insurance program funds, established and maintained to
purchase health services for uninsured, low-income children;
(2) To cover administrative costs associated with the
children's health insurance program; and
(3) To cover outreach activities associated with the
children's health insurance program and medicaid expansion.
(b) Moneys from the following sources may be deposited into
the fund:
(1) All public funds transferred by any public agency as
contemplated or permitted by applicable federal and state law;
(2) Any appropriations by the Legislature;
(3) All private moneys contributed, donated or bequeathed by
corporations, individuals or other entities as contemplated and
permitted by applicable federal and state law; and
(4) Any accrued interest and return on investments accruing to
the fund.
(c) Any balance remaining in the children's health insurance
fund at the end of any state fiscal year shall not revert to the
state treasury but shall remain in this fund and shall be used only
in a manner consistent with this article.
(d) Notwithstanding the provisions of section two, article
two, chapter twelve of this code, funds of the West Virginia
children's health fund may not be redesignated for any purpose
other than those set forth in this subsection.
§5-16B-9. Reporting.
(a) In addition to the reports provided for in sections one,
four and six of this article, the director shall, on a quarterly
basis, provide reports to the legislative oversight commission on
health and human resources accountability.
(b) The reports shall contain the number of covered children,
the number of children served, by age, including those covered
under medicaid, the numbers of new children enrolled for the
reporting period and current projections for future enrollees,
outreach efforts and programs, statistical profiles of the families
served, health status indicators of covered children, the average
annual cost of coverage per child, the total cost of all children
served by provider, provider type, type of service, contract
status, outcome measures for children served, reductions in
uncompensated care, performance with respect to the financial plan
and any other information as the legislative oversight commission on health and human resources accountability may require.
§5-16B-10. Public-private partnerships.
The board and the director are authorized to work in
conjunction with a nonprofit corporation organized pursuant to the
corporate laws of the state, structured to permit qualification
pursuant to Section 501(c) of the Internal Revenue Code for
purposes of assisting the children's health insurance program and
funded from sources other than the state or federal government.
Members of the board may sit on the board of directors of the
private nonprofit corporation.
CHAPTER 9. HUMAN SERVICES.
ARTICLE 4A. MEDICAID UNCOMPENSATED CARE FUND.
§9-4A-2b. Expansion of coverage to children and terminally ill.
(a) It is the intent of the Legislature that steps be taken to
expand coverage to children and the terminally ill and to pay for
this coverage by fully utilizing federal funds. To achieve this
intention, the department of health and human resources shall
undertake the following:
(1) Effective the first day of July, one thousand nine hundred
ninety-four. The department shall initiate provide a streamlined
application form, which shall be no longer than two pages, for all
families applying only for medicaid medical coverage for children
under any of the programs set forth in this section.
(2) Effective the first day of July, one thousand nine hundred ninety-four, the The department shall initiate provide the option
of hospice care to terminally ill West Virginians who otherwise
qualify for medicaid. On or before the first day of January, one
thousand nine hundred ninety-five, and periodically thereafter, The
department shall report provide quarterly reports to the
legislative task force on uncompensated health care and medicaid
expenditures oversight commission on health and human resources
accountability created pursuant to section four, article twenty-
nine-c twenty-nine-e, chapter sixteen of this code regarding the
program initiation provided for in this subdivision. The report
shall include, but not be limited to, the total number, by age, of
newly eligible clients served, as a result of the initiation of the
program pursuant to this subdivision the average annual cost of
coverage per client, and the total cost, by provider type, to serve
all clients.
(3) Effective the first day of July, one thousand nine hundred
ninety-four, the The department shall accelerate the medicaid
option for coverage of medicaid to all West Virginia children whose
family income is below one hundred percent of the federal poverty
level. On or before the first day of January, one thousand nine
hundred ninety-five, and periodically thereafter, The department
shall report provide quarterly reports to the legislative task
force on uncompensated health care and medicaid expenditures
oversight commission on health and human resources accountability regarding the program acceleration provided for in this
subdivision. The report shall include, but not be limited to, the
number of newly eligible clients, by age, served as a result of the
acceleration, the average annual cost of coverage per client and
the total cost of all clients served by provider type. The report
shall also include the medical services trust fund balance and the
future disproportionate share moneys expected to be deposited in
the medical services trust fund pursuant to section two-a of this
article.
(4)Effective the first day of July, one thousand nine
hundred ninety-five ninety-eight, the department may initiate the
medicaid option to shall expand coverage of medicaid to all West
Virginia children whose family income is below one hundred thirty- three percent of the federal poverty level the current medicaid
coverage of children below the age of six years whose family income
is below one hundred thirty-three percent of the federal poverty
level to include those West Virginia children below the age of six
years whose family income is between one hundred thirty-three
percent of the federal poverty level and one hundred fifty percent
of the federal poverty level. This program shall be administered
in accordance with the applicable provisions of Titles XIX and XXI
of the Social Security Act. To prepare for program expansion the
department shall submit a report to the governor and the
Legislature on the first day of January, one thousand nine hundred ninety-five, regarding the feasibility of the expansion. The
report is to include, but not be limited to, the number of newly
eligible clients participating in the programs specified in this
section, the average annual cost of coverage per client, the
percentage of expected participation for the expansion, the
projected cost of the expansion, the medical services trust fund
balance and the future disproportionate share moneys expected to be
deposited in the medical services trust fund pursuant to section
two-a of this article. The department shall continually update the
additional information required to be provided to the governor and
the Legislature regarding this expansion and periodically report
the information to the legislative task force on uncompensated
health care and medicaid expenditures created pursuant to section
four, article twenty-nine-c, chapter sixteen of this code.
(5) Effective the first day of July, one thousand nine hundred
ninety-six, the department may initiate the medicaid option to
expand coverage of medicaid to all West Virginia children whose
family income is below one hundred fifty percent of the federal
poverty level. To prepare for program expansion, the department
shall submit a report to the governor and the Legislature on the
first day of January, one thousand nine hundred ninety-six,
regarding the feasibility of the expansion. Additionally, the
report is to include, but not be limited to, the number of clients
who would be newly eligible to participate in the program, the average annual cost of coverage per client, by age, the percentage
of expected participation for the expansion and the projected cost
of the expansion, the balance of the medical services trust fund
and the future disproportionate share moneys expected to be
deposited in the medical services trust fund pursuant to section
two-a of this article. The department shall periodically update
and report to the legislative task force on uncompensated health
care and medicaid expenditures created pursuant to section four,
article twenty-nine-c, chapter sixteen of this code regarding the
additional information required to be submitted to the governor and
the Legislature.
(b) Notwithstanding the provisions of section two-a of this
article, the accruing interest in the medical services trust fund
may be utilized to pay for the programs specified in subdivisions
(2) and (3), subsection (a) of this section: Provided, That to the
extent the accrued interest is not sufficient to fully fund the
specified programs, the disproportionate share hospital funds paid
into the medical services trust fund after the thirtieth day of
June, one thousand nine hundred ninety-four, may be applied to
cover the cost of the specified programs. Provided, however, That
in fiscal year one thousand nine hundred ninety-five, the amount of
funds applied from the disproportionate share funds, not including
accrued interest, shall not exceed ten million dollars: Provided
further, That in the interest of fiscal responsibility, the department shall terminate the program specified in subdivisions
(4) and (5) of subsection (a) of this section, if the future moneys
deposited from disproportionate share payments in the medical
services trust fund are insufficient to cover the cost of the
expanded program.
(c) On the first day of January, one thousand nine hundred
ninety-five and annually thereafter, the The department shall
report annually to the governor and to the Legislature information
regarding the number of children and elderly covered by the program
programs in subdivisions (2) and (3), subsection (a) of this
section, the cost of services by type of service provided, a cost-
benefit analysis of the acceleration and expansion on other
insurers and the reduction of uncompensated care in hospitals as a
result of the programs.
(d) On the first day of January, one thousand nine hundred
ninety-nine, and annually thereafter, the department shall report
to the governor and to the Legislature information regarding the
number of children enrolled in the Title XIX medicaid program as a
result of implementation of the provisions of subdivision (4),
subsection (a) of this section; the number of children enrolled in
the new Title XXI medicaid program; the estimated number of
children eligible for enrollment in either program; the cost of
services by type of service provided in both programs; an analysis
of the impact of the programs on other insurers; and the reduction of uncompensated care in hospitals as a result of the programs.
The annual report filed by the department shall also include
information relating to any proposed expansion of the population to
be served under the state's medicaid program, other than the
expansions specifically authorized in this section. The department
may not expand the population to be served until sixty days
following the filing of the report required in this subsection.
The department shall make quarterly reports to the legislative
oversight commission on health and human resources accountability,
established pursuant to section four, article twenty-nine-e,
chapter sixteen of this code regarding the development,
implementation and monitoring of the program.
(d) (e)The health care cost review authority established by
section five, article twenty-nine-b of this chapter shall consider
in its rate review that uncompensated care and charity care are
reduced by the programs specified in subsection (a) of this section
and shall take the reduction into account when determining rates.
This determination shall be undertaken in each hospital's next rate
review and shall be determined prospectively.
(e) (f) On the first day of January, one thousand nine hundred
ninety-five ninety-nine, and annually thereafter, the health care
cost review authority shall present to the governor and to the
Legislature a report concerning the reduction in cost shift created
by the operation of the provisions of this article.
(f) The department shall review the additional utilization by
behavioral health centers as a result of the acceleration and
expansion for a period of eighteen months from the enactment of
this article: Provided, That during the eighteen month study
period the department shall not issue additional behavioral health
licenses: Provided, however, That this license provision does not
apply to facilities filing for renewal applications or to any
health care facility which has a certificate of need in effect or
an application pending on the first day of March, one thousand nine
hundred ninety-four: Provided further, That this licensure
prohibition shall not apply to behavior health services provided
pursuant to any agreement between state owned psychiatric hospitals
which are approved by the federal health care finance
administration.
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(NOTE: Strike-throughs indicate language that would be
stricken from the present law, and underscoring indicates new
language that would be added.
Article 5 is new; therefore, strike-throughs and underscoring
have been omitted.)