Senate Bill No. 507
(By Senator Chafin and Kessler)
[Introduced February 16, 2000; referred to the Committee
on Health and Human Resources; and then to the Committee on
A BILL to amend and reenact sections one and four, article four-b,
chapter nine of the code of West Virginia, one thousand nine
hundred thirty-one, as amended; and further amend said article
by adding thereto two new sections, designated sections two-a
and five-a, all relating to defining "registered nurse first
assistant"; defining perioperative nursing; defining roles for
licensed and unlicensed health care personnel; and
establishment of comparative fees for services provided by the
registered nurse first assistant.
Be it enacted by the Legislature of West Virginia:
That sections one and four, article four-b, chapter nine of the code of West Virginia, one thousand nine hundred thirty-one, as
amended, be amended and reenacted; and that said article be further
amended by adding thereto two new sections, designated sections
two-a and five-a, all to read as follows:
ARTICLE 4B. PHYSICIAN/MEDICAL PRACTITIONER PROVIDER MEDICAID ACT.
The following words when used in this article have meanings
ascribed to them in this section, except in those instances where
the context clearly indicates a different meaning:
(a) "Board" means the physician/medical practitioner provider
medicaid enhancement board created to develop, review and recommend
the physician/medical practitioner provider fee schedule.
(b) "Physician provider" means an allopathic or osteopathic
physician, rendering services within this state and receiving
reimbursement, directly as an individual provider or indirectly as
an employee or agent of a medical clinic, partnership or other
(c) "Nurse practitioner" means a registered nurse qualified by
virtue of his or her education and credentials and approved by the
West Virginia board of examiners for registered professional nurses
to practice as an advanced practice nurse independently or in a collaborative relationship with a physician.
(d) "Nurse-midwife" means a qualified professional nurse
registered with the West Virginia board of examiners for registered
professional nurses who by virtue of additional training is
specifically qualified to practice nurse-midwifery according to the
statement of standards for the practice of nurse-midwifery as set
forth by the American college of nurse-midwives.
(e) "Physician assistant" means an assistant to a physician
who is a graduate of an approved program of instruction in primary
health care or surgery, has attained a baccalaureate or master's
degree, has passed the national certification examination and is
qualified to perform direct patient care services under the
supervision of a physician.
(f) "Registered nurse first assistant" means one who:
(1) Holds a current active registered nurse licensure;
(2) Is certified in perioperative nursing; and
(3) Has successfully completed and holds a degree or
certificate from a recognized program which consists of:
(A) The Association of Operating Room Nurses, Inc., Care
Curriculum for the registered nurse first assistant; and
(B) One year of postbasic nursing study, which shall include at least forty-five hours of didactic instruction and one hundred
twenty hours of clinical internship or its equivalent of two
A registered nurse who was certified prior to 1995, by the
certification board of perioperative nursing is not required to
fulfill the requirements of subdivision (3) of this subsection.
(g) "Perioperative nursing" means a practice of nursing in
which the nurse provides perioperative, intraoperative and
postoperative nursing care to surgical patients.
(f) (h) "Secretary" means the secretary of the department of
health and human resources.
(g) (i) "Single state agency" means the single state agency
for medicaid in this state.
§9-4B-2a. Responsibilities of licensed and unlicensed health care
All health care facilities and services licensed under this
chapter shall include in their policies and procedures a care
delivery model based on patient needs which includes, but is not
limited to a policy that establishes the credentialing, oversight,
appointment and reappointment of the registered nurse first
assistant and for granting renewing and revising of the registered nurse first assistant's clinical privileges.
§9-4B-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: Provided, That reimbursement for the services
of a registered nurse first assistant shall be no less than 13.6
percent of the rate for a surgeon physician. 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) 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.
§9-4B-5a. The nurse first assistant health plan.
Notwithstanding any provision of law, a health plan issued or
renewed on or after the first day of July, two thousand, that
provides coverage for surgical first assistant benefits or services
shall be construed as providing coverage for a registered nurse
first assistant who performs services that are within the scope of
practice for the registered nurse first assistant.
NOTE: The purpose of this bill is to define the registered
nurse first assistant; establish the fee rate for a registered
nurse first assistant; and provide health insurance for the
registered nurse first assistant.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
§§9-4B-2a and 5a
are new; therefore, strike-throughs and
underscoring have been omitted.