Committee Substitute
House Bill 2091 History
OTHER VERSIONS -
Introduced Version
|
Engrossed Committee Substitute
|
| Email
Key: Green = existing Code. Red = new code to be enacted
COMMITTEE SUBSTITUTE
FOR
H. B. 2091
(By Delegates Perdue, Hatfield, Boggs, Campbell, Fleischauer and
Border)
(Originating in the House Committee on the Judiciary)
[March 23, 2009]
A BILL to amend and reenact §9-2-9 of the Code of West Virginia,
1931, as amended; and to amend and reenact §9-4-3 of said
code, all relating to requiring public notice and comment of
state plan amendments prior to submission for federal
approval; providing public notice and comment; excepting
public comment period in certain circumstances; allowing
emergency approval of certain rules; and expanding membership
of the Medicaid Advisory Board.
Be it enacted by the Legislature of West Virginia:
That §9-2-9 of the Code of West Virginia, 1931, as amended, be
amended and reenacted; and that §9-4-3 of said code be amended and
reenacted, all to read as follows:
ARTICLE 2. COMMISSIONER OF HUMAN SERVICES; POWERS, DUTIES AND
RESPONSIBILITIES GENERALLY.
§9-2-9. Secretary to develop Medicaid monitoring and case
management.
(a) 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.
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 is
a 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) 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.
(f) The secretary shall, upon federal certification of the
claims management system, ensure that the claims management system
processing Medicaid claims provides:
(1) Detailed quarterly financial reports to the Legislative
Oversight Commission on Health and Human Resources Accountability;
(2) A management reporting system no later than July 1, 2006;
and
(3) Specific utilization data by provider, member eligibility
groups and service no later than October 1, 2006.
(g) The secretary shall provide public notice of any proposed
amendment to the state plan for Medicaid or proposed changes to the
reimbursement schedule for Medicaid. The notice shall be filed
with the Secretary of State, for publication in the State Register,
including the text of the proposed amendment and a fiscal note. The notice shall fix a date, time and place for the receipt of
public comment in the form of written statements and any relevant
documents. The proposed amendment may not be filed for federal
approval until following the close of the public comment period.
If
the Secretary of the Department of Health and Human Resources
determines a submission or amendment of a
proposed amendment to
the state plan for Medicaid or proposed changes to the
reimbursement schedule for Medicaid
will have a substantial impact
on services, on benefits, or on payments to providers he or she
may, solely at his or her discretion, convene a public hearing.
When rules are necessary to conform to changes in state or federal
law where no agency discretion as to the substance of the rule is
involved, then the provisions of this subsection shall not apply.
However, if the Department of Health and Human Resources finds an
emergency exists requiring that emergency rules be promulgated
earlier than this subsection would permit, then such emergency
rules together with a statement of the circumstances constituting
the emergency shall be filed with the Secretary of State and a
notice of such filing shall be published in the State Register.
Such emergency rules shall become effective upon the approval of
the Secretary of State in accordance with section fifteen-a,
article three, chapter twenty-nine-a of this code, but promulgation
of such emergency rules shall not otherwise waive the department's
obligation to comply with this subsection.
ARTICLE 4. STATE ADVISORY BOARD; MEDICAL SERVICES FUND; ADVISORY
COUNCIL; GENERAL RELIEF FUND.
§9-4-3. Advisory council.
The advisory council, created by chapter one hundred
forty-three, Acts of the Legislature, regular session, 1953, as an
advisory body to the State Medicaid Agency with respect to the
medical services fund and disbursements therefrom and to advise
about health and medical services, is continued so long as the
medical services fund remains in existence, and thereafter so long
as the State Medicaid Agency considers the advisory council to be
necessary or desirable, and it is organized as provided by this
section and applicable federal law and has those advisory powers
and duties as are granted and imposed by this section and elsewhere
by law: Provided, That the continuation of the advisory council is
subject to a preliminary performance review pursuant to the
provisions of article ten, chapter four of this code, evaluating
the effectiveness and efficiency of the advisory council, to be
conducted during the interim of the Legislature in the year 2006 by
the Joint Committee on Government Operations.
The term of office of those members serving on the advisory
council, on the effective date of the amendments made to this
section by the Legislature during its regular session in the year
1998, shall continue until they are reappointed or replaced in
accordance with the provisions of this section.
The advisory council shall consist of not less than nine
members, nor more than thirteen 15 members, all but two four of
whom shall be appointed by the State Medicaid Agency and serve
until replaced or reappointed on a rotating basis. The heads of the Public Health and Public Welfare Agencies Bureau of Public
Health and Bureau for Medical Services are members ex officio. The
cochairs of the Legislative Oversight Commission on Health and
Human Resources Accountability, or their designees, are nonvoting
ex officio members. The remaining members comprising the council
consist of a person of recognized ability in the field of medicine
and surgery with respect to whose appointment the State Medical
Association shall be afforded the opportunity of making nomination
of three qualified persons, one member shall be a person of
recognized ability in the field of dentistry with respect to whose
appointment the State Dental Association shall be afforded the
opportunity of nominating three qualified persons, and the
remaining members shall be chosen from persons of recognized
ability in the fields of hospital administration, nursing and
allied professions and from consumers groups, including Medicaid
recipients, members of the West Virginia Directors of Senior and
Community Services, Labor Unions, Cooperatives and
Consumer-sponsored Prepaid Group Practices Plans.
The council shall meet on call of the state Medicaid Agency.
Each member of the advisory council shall receive reimbursement for
reasonable and necessary travel expenses for each day actually
served in attendance at meetings of the council in accordance with
the state's travel regulations. Requisitions for the expenses
shall be accompanied by an itemized statement, which shall be filed
with the Auditor and preserved as a public record.
The advisory council shall assist the State Medicaid Agency in the establishment of rules, standards and bylaws necessary to carry
out the provisions of this section and shall serve as consultants
to the State Medicaid Agency in carrying out the provisions of this
section.