H. B. 2506
(By Delegates Mezzatesta and Williams)
[Introduced January 22, 2003; referred to the
Committee on Health and Human Resources then Finance.]
A BILL to amend and reenact section six, article two-d, chapter
sixteen of the code of West Virginia, one thousand nine
hundred thirty-one, as amended; and to amend and reenact
sections thirty and thirty-one, article seven, chapter
forty-nine of said code, all relating to comprehensive
education programs for children placed in behavioral health
care facilities; requiring education plan approved by county
and state boards in certificate of need review; requiring
notice of approved plans to legislative oversight commission;
requiring education plan in procedures when certificate of
need not required; requiring payment of certain education
costs from in-state placement special account; clarifying
determination of savings from returning out-of-state
placements.
Be it enacted by the Legislature of West Virginia:
That section six, article two-d, chapter sixteen of the code
of West Virginia, one thousand nine hundred thirty-one, as amended,
be amended and reenacted; and that sections thirty and thirty-one,
article seven, chapter forty-nine of said code be amended and
reenacted, all to read as follows:
CHAPTER 16. PUBLIC HEALTH.
ARTICLE 2D. CERTIFICATE OF NEED.
§16-2D-6. Minimum criteria for certificate of need reviews.
(a) Except as provided in subsection (f), section nine of this
article, in making its determination as to whether a certificate of
need shall be is issued, the state agency shall, at a minimum,
consider all of the following criteria that are applicable:
Provided, That the criteria set forth in subsection (f) of this
section apply to all hospitals, nursing homes and health care
facilities when ventilator services are to be provided for any
nursing facility bed:
(1) The relationship of the health services being reviewed to
the state health plan;
(2) The relationship of services reviewed to the long-range
development plan of the person providing or proposing the services;
(3) The need that the population served or to be served by the
services has for the services proposed to be offered or expanded,
and the extent to which all residents of the area, and in
particular low income persons, racial and ethnic minorities, women, handicapped persons, other medically underserved population and the
elderly, are likely to have access to those services;
(4) The availability of less costly or more effective
alternative methods of providing the services to be offered,
expanded, reduced, relocated or eliminated;
(5) The immediate and long-term financial feasibility of the
proposal as well as the probable impact of the proposal on the
costs of and charges for providing health services by the person
proposing the new institutional health service;
(6) The relationship of the services proposed to the existing
health care system of the area in which the services are proposed
to be provided;
(7) In the case of health services proposed to be provided,
the availability of resources, including health care providers,
management personnel, and funds for capital and operating needs,
for the provision of the services proposed to be provided and the
need for alternative uses of these resources as identified by the
state health plan and other applicable plans;
(8) The appropriate and nondiscriminatory utilization of
existing and available health care providers;
(9) The relationship, including the organizational
relationship, of the health services proposed to be provided to
ancillary or support services;
(10) Special needs and circumstances of those entities which provide a substantial portion of their services or resources, or
both, to individuals not residing in the health service areas in
which the entities are located or in adjacent health service areas.
The entities may include medical and other health professional
schools, multidisciplinary clinics and specialty centers;
(11) In the case of a reduction or elimination of a service,
including the relocation of a facility or a service, the need that
the population presently served has for the service, the extent to
which that need will be met adequately by the proposed relocation
or by alternative arrangements, and the effect of the reduction,
elimination or relocation of the service on the ability of low
income persons, racial and ethnic minorities, women, handicapped
persons, other medically underserved population and the elderly, to
obtain needed health care;
(12) In the case of a construction project: (A) The cost and
methods of the proposed construction, including the costs and
methods of energy provision; and (B) the probable impact of the
construction project reviewed on the costs of providing health
services by the person proposing the construction project and on
the costs and charges to the public of providing health services by
other persons;
(13) In the case of health services proposed to be provided,
the effect of the means proposed for the delivery of proposed
health services on the clinical needs of health professional training programs in the area in which the services are to be
provided;
(14) In the case of health services proposed to be provided,
if the services are to be available in a limited number of
facilities, the extent to which the schools in the area for health
professions will have access to the services for training purposes;
(15) In the case of health services proposed to be provided,
the extent to which the proposed services will be accessible to all
the residents of the area to be served by the services;
(16) In accordance with section five of this article, the
factors influencing the effect of competition on the supply of the
health services being reviewed;
(17) Improvements or innovations in the financing and delivery
of health services which foster competition, in accordance with
section five of this article, and serve to promote quality
assurance and cost effectiveness;
(18) In the case of health services or facilities proposed to
be provided, the efficiency and appropriateness of the use of
existing services and facilities similar to those proposed;
(19) In the case of existing services or facilities, the
quality of care provided by the services or facilities in the past;
(20) In the case where an application is made by an
osteopathic or allopathic facility for a certificate of need to
construct, expand or modernize a health care facility, acquire major medical equipment or add services, the need for that
construction, expansion, modernization, acquisition of equipment or
addition of services shall be considered on the basis of the need
for and the availability in the community of services and
facilities for osteopathic and allopathic physicians and their
patients. The state agency shall consider the application in terms
of its impact on existing and proposed institutional training
programs for doctors of osteopathy and medicine at the student,
internship and residency training levels;
(21) The special circumstances of health care facilities with
respect to the need for conserving energy;
(22) The contribution of the proposed service in meeting the
health related needs of members of medically underserved
populations which have traditionally experienced difficulties in
obtaining equal access to health services, particularly those needs
identified in the state health plan as deserving of priority. For
the purpose of determining the extent to which the proposed service
will be accessible, the state agency shall consider:
(A) The extent to which medically underserved populations
currently use the applicant's services in comparison to the
percentage of the population in the applicant's service area which
is medically underserved, and the extent to which medically
underserved populations are expected to use the proposed services
if approved;
(B) The performance of the applicant in meeting its
obligation, if any, under any applicable federal regulations
requiring provision of uncompensated care, community service, or
access by minorities and handicapped persons to programs receiving
federal financial assistance, including the existence of any civil
rights access complaints against the applicant;
(C) The extent to which medicare, medicaid and medically
indigent patients are served by the applicant; and
(D) The extent to which the applicant offers a range of means
by which a person will have access to its services, including, but
not limited to, outpatient services, admission by a house staff and
admission by personal physician;
(23) The existence of a mechanism for soliciting consumer
input into the health care facility's decision making process; and
(24) In the case of behavioral health care facilities for
children who are placed out of their home, there shall be a
comprehensive education plan for the residents of the facility
which is approved by the board of education of the county where the
facility is located or proposed to be located and by the state
board of education. A certificate of need may not be granted
without an approved comprehensive education plan. The state board
shall submit an abstract of all such plans approved by it to the
legislative oversight commission on education accountability.
(b) The state agency may include additional criteria which it prescribes by rules adopted pursuant to section eight of this
article.
(c) Criteria for reviews may vary according to the purpose for
which a particular review is being conducted or the types of health
services being reviewed.
(d) An application for a certificate of need may not be made
subject to any criterion not contained in this article or not
contained in rules adopted pursuant to section eight of this
article.
(e) In the case of any proposed new institutional health
service, the state agency may not grant a certificate of need under
its certificate of need program unless, after consideration of the
appropriateness of the use of existing facilities providing
services similar to those being proposed, the state agency makes,
in addition to findings required in section nine of this article,
each of the following findings in writing: (1) That superior
alternatives to the services in terms of cost, efficiency and
appropriateness do not exist and the development of alternatives is
not practicable; (2) that existing facilities providing services
similar to those proposed are being used in an appropriate and
efficient manner; (3) that in the case of new construction,
alternatives to new construction, such as modernization or sharing
arrangements, have been considered and have been implemented to the
maximum extent practicable; (4) that patients will experience serious problems in obtaining care of the type proposed in the
absence of the proposed new service; and (5) that in the case of a
proposal for the addition of beds for the provision of skilled
nursing or intermediate care services, the addition will be
consistent with the plans of other agencies of the state
responsible for the provision and financing of long-term care
facilities or services including home health services.
(f) In the case where an application is made by a hospital,
nursing home or other health care facility to provide ventilator
services which have not previously been provided for a nursing
facility bed, the state agency shall consider the application in
terms of the need for the service and whether the cost exceeds the
level of current medicaid services. No facility may, by providing
ventilator services, provide a higher level of service for a
nursing facility bed without demonstrating that the change in level
of service by provision of the additional ventilator services will
result in no additional fiscal burden to the state.
(g) In the case where application is made by any person or
entity to provide personal care services which are to be billed for
medicaid reimbursement, the state agency shall consider the
application in terms of the need for the service and whether the
cost exceeds the level of the cost of current medicaid services.
No person or entity may provide personal care services to be billed
for medicaid reimbursement without demonstrating that the provision of the personal care service will result in no additional fiscal
burden to the state: Provided, That a certificate of need is not
required for a person providing specialized foster care personal
care services to one individual and those services are delivered in
the provider's home. The state agency shall also consider the
total fiscal liability to the state for all applications which have
been submitted.
CHAPTER 49. CHILD WELFARE.
ARTICLE 7. GENERAL PROVISIONS.
§49-7-30. Certificate of need not required.
(a) A certificate of need, as provided for in article two-d,
chapter sixteen of this code, is not required by an entity
proposing behavioral health care facilities or behavioral health
care services for children who are placed out of their home, or who
are at imminent risk of being placed out of their home, if a
summary review is performed in accordance with the provisions of
this section.
(b) A summary review of proposed health care facilities or
health care services for children who are placed out of their home,
or who are at imminent risk of being placed out of their home, is
initiated when the proposal is recommended to the health care cost
review authority by the secretary of the department of health and
human resources, and the secretary has made the following findings:
(1) That the proposed facility or service is consistent with the state health plan;
(2) That the proposed facility or service is consistent with
the department's programmatic and fiscal plan for behavioral health
services for children with mental health and addiction disorders;
(3) That the proposed facility or service contributes to
providing services that are child and family driven, with priority
given to keeping children in their own homes;
(4) That the proposed facility or service will contribute to
reducing the number of child placements in out-of-state facilities
by making placements available in in-state facilities;
(5) That the proposed facility or service contributes to
reducing the number of child placements in in-state or out-of-state
facilities by returning children to their families, placing them in
foster care programs, or making available school-based and
out-patient services; and
(6) If applicable, that the proposed services will be
community-based, locally accessible, and provided in an appropriate
setting consistent with the unique needs and potential of each
child and his or her family; and
(7) There is a comprehensive education plan for the residents
of the facility which is approved by the board of education of the
county where the facility is located or proposed to be located and
by the state board of education. The state board shall submit an
abstract of all such plans approved by it to the legislative oversight commission on education accountability.
(c) The secretary's findings required by subsection (b) of
this section shall be filed with the secretary's recommendation and
appropriate documentation. If the secretary's findings are
supported by the accompanying documentation, the proposal shall
does not require a certificate of need.
(d) Any entity that does not qualify for summary review shall
be is subject to certificate of need review.
§49-7-31. Special account.
(a) There is hereby established a continued the special
account in for the department of health and human resources in the
state treasury to be known as the "Child Assessment and In-state
Placement Fund." Any funds provided for the purposes of this
article by line-item appropriation of the Legislature in any fiscal
year shall be deposited in the special account and used to carry
out the purposes of this article. Balances remaining in the
special account at the end of the fiscal year shall do not expire
or revert to the general revenue: Provided, That balances
remaining in the account may be redesignated for other purposes by
appropriation of the Legislature. The secretary of the department
of health and human resources may order the transfer of moneys in
the special account to other accounts within the department of
health and human resources, to the limited extent that children who
are the subject of this article are financially and medically eligible for other programs or services of the division of health
and human resources, including programs funded, in whole or in
part, by federal funds.
(b) Any moneys saved by the department of health and human
resources by virtue of returning children from out-of-state
placements after implementing the structured risk assessment and
classification system provided for in section four, article nine of
this chapter shall be deposited in the child assessment and in-
state placement fund and used solely for the purpose of developing
and implementing programs that will reduce the numbers of children
in long-term placements outside of their homes.
(c) Any moneys necessary for a county board to provide a
comprehensive education program for children placed out of their
home in a behavioral health care facility for children in this
state, in excess of those paid under the public school support plan
or other state or federal sources, shall be paid from the special
account under this section. Money saved by virtue of returning
children from out-of-state placements only includes money saved in
excess of the costs required to provide for a comprehensive
education program for those returning children who are returning to
a placement in a behavioral health facility placement in this
state.
NOTE: The purpose of this bill is to require as part of the
approval process for behavioral health facilities for children, an
education plan approved by the county and state board. Any expense
of providing a comprehensive education program for children placed
in an in-state behavioral health facility, in excess of funds
provided through the school aid formula, is to be paid from a
special fund in the Department of Health and Human Resources.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.