Senate Bill No. 688
(By Senators Schoonover and Love)
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[Introduced February 23, 1998; referred to the
Committee on Health and Human Resources.]
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A BILL to amend and reenact section two, article one, chapter
nine of the code of West Virginia, one thousand nine hundred
thirty-one, as amended; and to amend article five of said
chapter by adding thereto a new section, designated section
five-a, all relating to the division of human services;
defining the state medicaid agency; and providing authority
to revoke eligibility for medicaid benefits for abuse or
misuse of benefits.
Be it enacted by the Legislature of West Virginia:
That section two, article one, chapter nine of the code of
West Virginia, one thousand nine hundred thirty-one, as amended,
be amended and reenacted; and that article five of said chapter
be amended by adding thereto a new section, designated section
five-a, all to read as follows:
ARTICLE 1. LEGISLATIVE PURPOSE AND DEFINITIONS.
§9-1-2. Definitions.
The following words and terms when used in this chapter
shall have the meaning hereafter ascribed to them meanings
indicated unless the context clearly indicates a different
meaning, and any amendment of this section shall apply applies to
any verdict, settlement, compromise or judgment entered after the
effective date of the amendments to this section enacted during
the regular session of the Legislature, one thousand nine hundred
ninety-five.
(a) The term "department" means the state division of human
services.
(b) The term "commissioner" means the commissioner of human
services.
(c) The term "federal-state assistance" means and includes
(1) all forms of aid, care, assistance and services to or on
behalf of persons, which are authorized by, and who are
authorized to receive the same under and by virtue of,
subchapters one, four, five, ten, fourteen, sixteen, eighteen and
nineteen, chapter seven, Title 42, United States Code, as those
subchapters have heretofore been and may hereafter be amended,
supplemented and revised by acts of Congress, and as those
subchapters so amended, supplemented and revised have heretofore been and may hereafter be supplemented by valid rules and
regulations promulgated by authorized federal agents and
agencies, and as those subchapters so amended, supplemented and
revised have heretofore been and may hereafter be supplemented by
rules and regulations promulgated by the state division of human
services, which division rules and regulations shall be
consistent with federal laws, rules and regulations, but not
inconsistent with state law, and (2) all forms of aid, care,
assistance and services to persons, which are authorized by, and
who are authorized to receive the same under and by virtue of,
any act of Congress, other than the federal Social Security Act,
as amended, for distribution through the state division of human
services to recipients of any form of aid, care, assistance and
services to persons designated or referred to in (1) of this
definition and to recipients of state assistance, including by
way of illustration, surplus food and food stamps, which Congress
has authorized the secretary of agriculture of the United States
to distribute to needy persons.
(d) The term "federal assistance" means and includes all
forms of aid, care, assistance and services to or on behalf of
persons, which are authorized by, and who are authorized to
receive the same under and by virtue of, any act of Congress for
distribution through the state division of human services, the cost of which is paid entirely out of federal appropriations.
(e) The term "state assistance" means and includes all forms
of aid, care, assistance, services and general relief made
possible solely out of state, county and private appropriations
to or on behalf of indigent persons, which are authorized by, and
who are authorized to receive the same under and by virtue of,
state division of human services' rules. and regulations
(f) The term "welfare assistance" means the three classes of
assistance administered by the state division of human services,
namely: Federal-state assistance, federal assistance and state
assistance.
(g) The term "indigent person" means any person who is
domiciled in this state and who is actually in need as defined by
department rules and regulations and has not sufficient income or
other resources to provide for such need as determined by the
state division of human services.
(h) The term "domiciled in this state" means being
physically present in West Virginia accompanied by an intention
to remain in West Virginia for an indefinite period of time, and
to make West Virginia his or her permanent home. The state
division of human services may by rules and regulations
supplement the foregoing definition of the term "domiciled in
this state", but not in such a manner as would be inconsistent with federal laws, rules, and regulations applicable to and
governing federal-state assistance.
(i) The term "medical services" means medical, surgical,
dental and nursing services, and other remedial services
recognized by law, in the home, office, hospital, clinic and any
other suitable place, provided or prescribed by persons permitted
or authorized by law to give such services; such the services to
include drugs and medical supplies, appliances, laboratory,
diagnostic and therapeutic services, nursing home and
convalescent care and such other medical services and supplies as
may be prescribed by such the persons.
(j) The term "general relief" means cash or its equivalent
in services or commodities expended for care and assistance to an
indigent person other than for care in a county infirmary, child
shelter or similar institution.
(k) The term "secretary" means the secretary of the
department of health and human resources.
(l) The term "estate" means all real and personal property
and other assets included within the individual's estate as
defined in the state's probate law.
(m) The term "services" means nursing facility services,
home and community-based services, and related hospital and
prescription drug services for which an individual received medicaid medical assistance.
(n) The term "state medicaid agency" means the division of
the department of health and human resources that is the
federally designated single state agency charged with
administration and supervision of the state medicaid program.
ARTICLE 5. MISCELLANEOUS PROVISIONS.
9-5-5a. Revocation of eligibility for medicaid benefits for
abuse or misuse of benefits.
(a) Upon determination by the state medicaid agency that a
medicaid recipient has abused or misused the benefits of the
program, the recipient is, after notice and hearing, ineligible
for medicaid benefits.
(b) Medicaid recipients whose eligibility is revoked due to
abuse or misuse of the program are not eligible for future
medicaid services for a period of not less than one year and
until full restitution has been made to the state medicaid
agency.
(c) When a medicaid recipient, whose eligibility has been
revoked due to abuse or misuse of the program, reapplies for
coverage during the period of suspension due to a pregnancy, the
review committee for the state medicaid agency may change the
suspended status of the recipient to restricted status where it
has been determined that it would be in the best interest of the child for the mother to receive coverage for pregnancy related
services. When the change in status is granted, the case shall
be reconsidered by the state medicaid agency within sixty days
after the birth of the child or termination of pregnancy related
services for further action.
NOTE: The purpose of this bill is to define the State
Medicaid Agency and provide authority to revoke eligibility for
Medicaid benefits for abuse or misuse of benefits.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.
Section 9-5-5a is new; therefore, strike-throughs and
underscoring have been omitted.