ENROLLED
Senate Bill No. 608
(By Senator Prezioso)
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[Passed March 8, 2003; in effect ninety days from passage.]
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AN ACT to amend and reenact section nineteen, article five, chapter
nine of the code of West Virginia, one thousand nine hundred
thirty-one, as amended, relating to allowing the continuance
of summary certificate of need reviews for proposed behavioral
health services necessary to maintain federal approval of the
medicaid mentally retarded/developmentally disabled waiver
program.
Be it enacted by the Legislature of West Virginia:
That section nineteen, article five, 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 5. MISCELLANEOUS PROVISIONS.
§9-5-19. Summary review for certain behavioral health facilities
and services.
(a) A certificate of need as provided in article two-d,
chapter sixteen of this code is not required by an entity proposing
additional behavioral health care services, but only to the extent necessary to gain federal approval of the medicaid MR/DD waiver
program, if a summary review is performed in accordance with the
provisions of this section.
(b) Prior to initiating any summary review, the secretary
shall direct the revision of the state mental health plan as
required by the provisions of 42 U. S. C. 300x and section four,
article one-a, chapter twenty-seven of this code. In developing
those revisions, the secretary is to appoint an advisory committee
composed of representatives of the associations representing
providers, child care providers, physicians and advocates. The
secretary shall appoint the appropriate department employees
representing regulatory agencies, reimbursement agencies and
oversight agencies of the behavioral health system.
(c) If the secretary of the department of health and human
resources determines that specific services are needed but
unavailable, he or she shall provide notice of the department's
intent to develop those services. Notice may be provided through
publication in the state register, publication in newspapers or a
modified request for proposal as developed by the secretary.
(d) The secretary may initiate a summary review of additional
behavioral health care services, but only to the extent necessary
to gain federal approval of the medicaid MR/DD waiver program, by
recommending exemption from the provisions of article two-d,
chapter sixteen of this code to the health care authority. The recommendation is to include the following findings:
(1) That the proposed service is consistent with the state
health plan and the state mental health plan;
(2) That the proposed service is consistent with the
department's programmatic and fiscal plan for behavioral health
services;
(3) That the proposed service contributes to providing
services that prevent admission to restrictive environments or
enables an individual to remain in a nonrestrictive environment;
(4) That the proposed service contributes to reducing the
number of individuals admitted to inpatient or residential
treatment programs or services;
(5) If applicable, that the proposed service will be
community-based, locally accessible, provided in an appropriate
setting consistent with the unique needs and potential of each
client and his or her family and located in an area that is
unserved or underserved or does not allow consumers a choice of
providers; and
(6) That the secretary is determining that sufficient funds
are available for the proposed service without decreasing access to
or provision of existing services. The secretary may, from time to
time, transfer funds pursuant to the general provisions of the
budget bill.
(e) The secretary's findings required by 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 does not require a
certificate of need.
(f) Any entity that does not qualify for summary review is
subject to a certificate of need review.
(g) Any provider of the proposed services denied authorization
to provide those services pursuant to the summary review has the
right to appeal that decision to the state agency in accordance
with the provisions of section ten, article two-d, chapter sixteen
of this code.