Enrolled Committee Substitute
House Bill 2885 History
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ENROLLED
COMMITTEE SUBSTITUTE
FOR
H. B. 2885
(By Delegates Perdue, Hatfield, Marshall,
Michael, Moore, Rodighiero and Border)
[Passed April 11, 2009; in effect ninety days from passage.]
AN ACT to amend and reenact §16-1A-1, §16-1A-3 and §16-1A-4 of the
Code of West Virginia, 1931, as amended; and to amend said
code by adding thereto a new section, designated §16-1A-5, all
relating to uniform credentialing for health care providers;
defining terms; establishing the composition of the advisory
committee; requiring the advisory committee to develop
proposed legislation to establish credentialing verification
organization or organizations, and the disposition of existing
organizations; describing the duties of CVOs; describing the
procedures for completion of verification; establishing time
frames for credentialing; requiring all health care
practitioners and insurers, hospitals, third party
administrators and other health care entities to use the CVO
and the credentialing form; developing credentialing
requirements; developing privacy considerations; providing
penalties; and requiring a report to the Legislature regarding proposed legislation on or before January 1, 2010.
Be it enacted by the Legislature of West Virginia:
That §16-1A-1, §16-1A-3 and §16-1A-4 of the Code of West
Virginia, as amended, be amended and reenacted; and that said code
be amended by adding thereto a new section, designated §16-1A-5,
all to read as follows:
ARTICLE 1A. UNIFORM CREDENTIALING FOR HEALTH CARE PRACTITIONERS.
§16-1A-1. Legislative findings; purpose.
(a) The Legislature finds:
(1) Credentialing, required by hospitals, insurance companies,
prepaid health plans, third party administrators and other health
care entities, is necessary to assess and verify the education,
training and experience of health care practitioners to ensure that
qualified professionals treat the citizens of this state.
(2) Currently, a credentialing application form has been
created to reduce duplication and increase efficiency. Each health
care entity performs primary source verification for the
practitioners who apply to that entity for affiliation. This
duplication of primary source verification is time consuming and
costly.
(3) The Secretary of the Department of Health and Human
Resources and the Insurance Commissioner share regulatory authority
over the entities requiring credentialing.
(b) The purpose of this article is to continue the advisory
committee to assist in developing a uniform credentialing process
and to develop legislation regarding the use of uniform credentialing through one or more credentialing verification
organizations in this state.
§16-1A-3. Definitions.
(a) "Commissioner" is the Office of the Insurance
Commissioner.
(b) "CVO" is a Credentialing Verification Organization which
performs primary source verification of all health care
practitioners' training, education and experience.
(c) "The department" is the Department of Health and Human
Resources;
(d) "Health care practitioners" means those established
pursuant to section two of this article in legislative rule.
(e) "Joint Commission" is an independent not-for-profit
organization that evaluates and accredits more than 15,000 health
care organizations and programs in the United States.
(f) "NCQA" means the National Committee for Quality Assurance,
which is a private, 501(c)(3) not-for-profit organization dedicated
to improving health care quality.
(g) "Primary source verification procedure" means the
procedure used by a credentialing organization to collect, verify
and maintain the accuracy of documents and credentialing
information submitted to it by a health care practitioner who is
applying for affiliation with a health care entity.
(h) "URAC" means the American Accreditation Healthcare
Commission.
(I) "Payor" means an insurer, prepaid health plan, hospital service corporation, third party administrator as defined in
article forty-six, chapter thirty-three of this code, or any other
entity that reimburses health care practitioners for medical
services.
§16-1A-4. Advisory committee.
(a) The Secretary of the Department of Health and Human
Resources and the Insurance Commissioner shall jointly establish an
advisory committee to assist them in the development and
implementation of the uniform credentialing process in this state.
The advisory committee shall consist of thirteen appointed members.
Six members shall be appointed by the Secretary of the Department
of Health and Human Resources: One member shall represent a
hospital with one hundred beds or less; one member shall represent
a hospital with more than one hundred beds; one member shall
represent another type of health care facility requiring
credentialing; one member shall be a person currently credentialing
on behalf of health care practitioners; and two of the members
shall represent the health care practitioners subject to
credentialing. Five members shall be representative of the
entities regulated by the Insurance Commissioner that require
credentialing and shall be appointed by the Insurance Commissioner:
One member shall represent an indemnity health care insurer; one
member shall represent a preferred provider organization; one
member shall represent a third party administrator; one member
shall represent a health maintenance organization accredited by
URAC; and one member shall represent a health maintenance organization accredited by the national committee on quality
assurance. The Secretary of the Department of Health and Human
Resources and the Insurance Commissioner, or the designee of either
or both, shall be nonvoting ex officio members. Upon the effective
date of this legislation, the state hospital association and state
medical association shall each designate to the department one
person to represent their respective associations and members and
those designees shall be appointed to the advisory committee by the
secretary of the department.
(b) At the expiration of the initial terms, successors will be
appointed to terms of three years. Members may serve an unlimited
number of terms. When a vacancy occurs as a result of the
expiration of a term or otherwise, a successor of like
qualifications shall be appointed. Representatives of the hospital
and medical associations shall serve for three-year terms.
(c) The advisory committee shall meet at least annually to
review the status of uniform credentialing in this state, and may
make further recommendations to the Secretary of the Department of
Health and Human Resources and the Insurance Commissioner as are
necessary to carry out the purposes of this article. Any uniform
forms and the list of health care practitioners required to use the
uniform forms as set forth in legislative rule proposed pursuant to
section two of this article may be amended as needed by procedural
rule.
§16-1A-5. Development of legislation regarding CVO; report
required.
(a) On or before January 1, 2010, the advisory committee
established pursuant to section four of this article shall develop
legislation that considers the following:
(1) The establishment of one or more CVOs within the state to
provide primary source verification with electronic accessibility
on a cost effective and operationally efficient basis;
(2) The number of CVOs necessary to provide this access for
the state;
(3) The treatment of existing CVOs currently doing business
within the state;
(4) The duties of a CVO and the timelines for completion of
its verification duties;
(5) The procedures for maintaining healthcare practitioner
files;
(6) The payment system to cover the costs of the credentialing
program;
(7) The use and confidentiality of data generated, collected
and maintained by a CVO;
(8) Compliance by CVOs with certificate requirements including
NCQA, URAC, Medicare and Medicaid and other state and federal
requirements;
(9) The required use by payors and hospitals of a CVO's
primary source verification services;
(10) Credentialing recredentialing requirements as required by
payors, hospitals and state and federal law and regulations;
(11) The use of site visits in credentialing;
(12) The maintenance, amounts and types of liability insurance
to be obtained by a CVO;
(13) Consideration of existing statutory protections that
should be extended to the CVO;
(14) Privacy considerations;
(15) If applicable, the terms and conditions of the contract
under which a CVO operates in this state and the procedure and
criteria upon which a CVO is selected;
(16) Penalties, if any, for noncompliance;
(17) Timelines for credentialing, recredentialing and other
compliance obligation of payors;
(18) Reconciliation of the use of forms required by this
article with other applicable state and federal laws and
regulations.
(b) On or before January 1, 2010, the department and the
commissioner shall jointly report to the Legislative Oversight
Commission on Health and Human Resources Accountability proposed
legislation to implement the provisions set forth in this article.