H. B. 2468
(By Delegates Border, Perdue, Ashley, Campbell,
Staton, Browning and Michael)
[Introduced January 21, 2003; referred to the
Committee on Health and Human Resources then Finance.]
A BILL to amend and reenact section nine, article two, chapter nine
of the code of West Virginia, one thousand nine hundred
thirty-one, as amended, relating to responsibilities of the
secretary of the department of health and human resources and
requiring that the secretary ensure that medicaid
reimbursement for prescriptions from retail pharmacies allow
for reimbursement for the smallest available package when a
medicine is not available in the prescribed dosage.
Be it enacted by the Legislature of West Virginia:
That section nine, article two, 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 2. DEPARTMENT OF HEALTH AND HUMAN RESOURCES, AND OFFICE OF
COMMISSIONER OF HUMAN SERVICES; POWERS, DUTIES AND
RESPONSIBILITIES GENERALLY.
§9-2-9. Secretary to develop medicaid monitoring and case
management.
(a) On or before the first day of January, one thousand nine
hundred ninety-four, the secretary of the department of health and
human resources shall:
(1) Develop a managed care system to monitor the services
provided by the medicaid program to individual clients;
(2) Develop an independent referral service, including the
review of individual cases for abuses of the program; and
(3) Develop a schedule for implementation of the managed care
and independent referral system. The managed care system shall
focus on, but not be limited to, the behavioral health and mental
health services.
(b) In addition thereto, and in accordance with applicable
federal medicaid laws, the secretary shall prepare recommendations,
to be submitted to the joint committee on government and finance on
or before the first day of January, one thousand nine hundred
ninety-four. In developing recommendations the secretary shall
consider as options the following:
(1) Review of medicaid services which are optional under
federal medicaid law and identification of services to be retained,
reduced or eliminated;
(2) The elimination, reduction or phase-out of: (i) Services
which are not generally available to West Virginia citizens not covered under the state's medicaid program; or (ii) services which
are not generally covered under group policies of insurance made
available to employees of employers within the state;
(3) The elimination or reduction of services, or reduction of
provider reimbursement rates, for identified services of marginal
utility;
(4) Higher reimbursement rates for primary and preventive care;
(5) Changes in fee structure, which may include a system of
prospective payments, and may include establishment of global fees
for identified services or diagnoses including maternity care;
(6) Utilization caps for certain health care procedures;
(7) Restriction of coverage for cosmetic procedures;
(8) Identification of excessive use of certain health care
procedures by individuals and a policy to restrict excessive use;
(9) Identification of services which reduce the need for more
costly options for necessary care and retention or expansion of
those programs;
(10) Identification of services for which preauthorization
should be requirement for medicaid reimbursement;
(11) Recommendations relating to the development of a
demonstration project on long-term care, which demonstration project
may be limited to patients with Alzheimer's disease;
(12) A policy concerning the department's procedures for
compliance, monitoring and inspection; and
(13) Ensure that medicaid reimbursement for prescription drugs
reimburse retail pharmacies for the cost of smallest available
prescription package when a medicine is prescribed in a dosage which
is less than the smallest available package and where the breakage
of the package for a lesser dosage results in the inability of the
pharmacy to sell the remaining portion of the broken package; and
(13) (14) Such other options as may be developed.
(c) The secretary shall utilize in-state health care facilities
for inpatient treatment when such facilities are available. Prior
authorization, consistent with applicable federal law, shall be
required for out-of-state inpatient treatment.
(d) The secretary shall report to the joint committee on
government and finance on the development and implementation of
medicaid programs that provide incentives to working persons. The
secretary shall consider: Subsidies for low income working persons;
individual or small employer buy-ins to the state medicaid fund;
prospective payment systems for primary care physicians in
underserved areas; and a system to improve monitoring of
collections, expenditures, service delivery and utilization.
(e) The secretary shall report quarterly to the joint
committee on government and finance regarding provider and facility
compliance with federal and state medicaid laws, including, but not
limited to, the following: The number of inspections conducted
during the previous quarter; description of programs, services and facilities reviewed; findings; and recommendations for corrections.
NOTE: The purpose of this bill is to require the Secretary of
the Department of Health and Human Resources to e
nsure that
medicaid reimbursement for prescription drugs reimburse retail
pharmacies for the cost of smallest available prescription package.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.