Senate Bill No. 667
(By Senators Hunter, White, Ross, Boley, McKenzie, Love, Ball,
Schoonover and Minear)
____________
[Introduced February 23, 1998; 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 four, article four-b, chapter
nine of the code of West Virginia, one thousand nine hundred
thirty-one, as amended, relating to authorizing medicaid
payments
for venipuncture for obtaining a blood sample
performed by a skilled nursing care service if ordered by a
physician/medical practitioner
.
Be it enacted by the Legislature of West Virginia:
That section four, article four-b, 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 4B. PHYSICIAN/MEDICAL PRACTITIONER PROVIDER MEDICAID
ACT.
ยง9-4B-4. Powers and duties.
(a) The board shall:
(1) Develop and recommend a reasonable physician/medical
practitioner provider
fee schedule that conforms with federal
medicaid laws and remains within the limits of annual funding
available to the single state agency for the medicaid program.
In developing the fee schedule, the board may refer to a
nationally published regional specific fee schedule selected by
the secretary of the department of health and human resources.
The board may consider identified health care priorities in
developing its fee schedule to the extent permitted by applicable
federal medicaid laws and may recommend higher reimbursement
rates for basic primary and preventive health care services than
for other services. In identifying basic primary and preventive
health care services and in accordance with applicable federal
medicaid laws, the board may consider factors, including, but not
limited to, services defined and prioritized by the basic
services task force of the health care planning commission in its
report issued in December of the year one thousand nine hundred
ninety-two; and minimum benefits and
coverages for policies of
insurance as set forth in section fifteen, article fifteen,
chapter thirty-three of this code and section four, article
sixteen-c of said chapter and rules of the insurance commissioner
promulgated thereunder. If the single state agency approves the fee schedule, it shall implement the physician/medical
practitioner provider
fee schedule;
(2) Review the fee schedule on a quarterly basis and
recommend to the single state agency any adjustments it considers
necessary. If the single state agency approves any of the
board's recommendations, it shall immediately implement those
adjustments and shall report the same to the joint committee on
government and finance on a quarterly basis;
(3) Meet and confer with representatives from each medical
specialty area so that equity in reimbursement increases or
decreases be achieved to the greatest extent possible;
(4) Assist and enhance communications between participating
physician and medical practitioner providers and the department
of health and human resources; and
(5) Review reimbursements in relation to those physician and
medical practitioner providers who provide early and periodic
screening diagnosis and treatment
.
(b) The board may carry out any other powers and duties as
prescribed for it by the secretary.
(c) Nothing in this section gives the board the authority to
interfere with the discretion and judgment given to the single
state agency that administers the state's medicaid program. If
the single state agency disapproves the recommendations or
adjustments to the fee schedule, it is expressly authorized to make any modifications to fee schedules as are necessary to
ensure that total financial requirements of the agency for the
current fiscal year with respect to the state's medicaid plan are
met and shall report the same to the joint committee on
government and finance on a quarterly basis. The purpose of the
board is to assist and enhance the role of the single state
agency in carrying out its mandate by acting as a means of
communication between the medicaid provider community and the
agency.
(d) Notwithstanding any other provision of the law to the
contrary, the board shall develop and recommend a fee schedule
for venipuncture for the purpose of obtaining a blood sample
performed by a skilled nursing care service if ordered by a
physician/medical practitioner.
(d) (e) On a quarterly basis, the single state agency and
the board shall report to the joint committee on government and
finance the status of the fund, any adjustments to the fee
schedule and the fee schedule for each health care provider group
identified in section one of this article.
NOTE: The purpose of this bill is to authorize medicaid
payments
for venipuncture for obtaining a blood sample performed
by a skilled nursing care service if ordered by a
physician/medical practitioner
.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language that would be added.