Senate
House
Joint
Bill Status
WV Code
Audits/ Reports
Educational
Contact
home
home

SB414 SUB1 Senate Bill 414 History

OTHER VERSIONS  -  Introduced Version  |  DOWNLOAD  wpd  |  Email


SB414 SUB1
COMMITTEE SUBSTITUTE

FOR

Senate Bill No. 414

(By Senators Prezioso, Foster, Jenkins, Stollings, Caruth, Laird, Unger, Minard and Kessler)

____________

[Originating in the Committee on Health and Human Resources;

reported March 20, 2009.]

____________


A BILL to repeal §5-16-7b of the Code of West Virginia, 1931, as amended; to repeal §5-16C-1, §5-16C-2, §5-16C-3, §5-16C-4, §5-16C-5, §5-16C-6, §5-16C-7, §5-16C-8, §5-16C-9 and §5-16C-10 of said code; to repeal §5A-3-1a of said code; to repeal §5A-3C-1, §5A-3C-2, §5A-3C-3, §5A-3C-4, §5A-3C-5, §5A-3C-6, §5A-3C-7, §5A-3C-8, §5A-3C-9, §5A-3C-10, §5A-3C-11, §5A-3C-12, §5A-3C-13, §5A-3C-14, §5A-3C-15, §5A-3C-16 and §5A-3C-17 of said code; to amend and reenact §5F-2-5 of said code; to amend and reenact §16-2J-2 of said code; to amend said code by adding thereto a new article, designated §16-2L-1, §16-2L-2, §16-2L-3, §16-2L-4 and §16-2L-5; to amend and reenact §16-29H-1, §16-29H-2, §16-29H-3, §16-29H-4 and §16-29H-5 of said code; and to amend said code by adding thereto sixteen new sections, designated §16-29H-6, §16-29H-7, §16-29H-8, §16- 29H-9, §16-29H-10, §16-29H-11, §16-29H-12, §16-29H-13, §16- 29H-14, §16-29H-15, §16-29H-16, §16-29H-17, §16-29H-18, §16-29H-19, §16-29H-20 and §16-29H-21, all relating generally to the creation of the Governor's Office of Health Enhancement and Lifestyle Planning; setting forth legislative findings; setting forth the powers and duties of the office; transferring the powers and duties of the Pharmaceutical Cost Management Council to the office; creating the position of director; setting forth the qualifications of the director; setting forth the powers and duties of the director; providing for staff; requiring the development of a five-year strategic plan; providing for legislative rule-making authority; providing for coordination with various state agencies, departments, boards, bureaus and commissions; requiring reporting to the Governor and the Legislature; establishing pilot projects for patient-centered medical homes; setting forth legislative findings; defining terms; evaluating existing medical home pilot programs; establishing criteria for pilot projects for patient-centered medical homes; defining four types of pilot projects; setting forth evaluation criteria; and granting rule-making authority.

Be it enacted by the Legislature of West Virginia:
That §5-16-7b of the Code of West Virginia, 1931, as amended, be repealed; that §5-16C-1, §5-16C-2, §5-16C-3, §5-16C-4, §5-16C-5, §5-16C-6, §5-16C-7, §5-16C-8, §5-16C-9 and §5-16C-10 of said code be repealed;
that §5A-3-1a of said code be repealed; that §5A-3C-1, §5A-3C-2, §5A-3C-3, §5A-3C-4, §5A-3C-5, §5A-3C-6, §5A-3C-7, §5A-3C-8, §5A-3C-9, §5A-3C-10, §5A-3C-11, §5A-3C-12, §5A-3C-13, §5A-3C-14, §5A-3C-15, §5A-3C-16 and §5A-3C-17 of said code be repealed; that §5F-2-2 of said code be amended and reenacted; that §16-2J-2 of said code be amended and reenacted; that said code be amended by adding thereto a new article, designated §16-2L-1, §16-2L-2, §16-2L-3, §16-2L-4 and §16-2L-5; that §16-29H-1, §16-29H-2, §16-29H-3, §16-29H-4 and §16-29H-5 of said code be amended and reenacted; and that said code be amended by adding thereto sixteen new sections, designated §16-29H-6, §16-29H-7, §16- 29H-8, §16-29H-9, §16-29H-10, §16-29H-11, §16-29H-12, §16-29H-13, §16-29H-14, §16-29H-15, §16-29H-16, §16-29H-17, §16-29H-18, §16- 29H-19, §16-29H-20 and §16-29H-21, all to read as follows:
CHAPTER 5F. ORGANIZATION OF THE EXECUTIVE BRANCH

OF STATE GOVERNMENT.

ARTICLE 2. TRANSFER OF AGENCIES AND BOARDS.
§5F-2-2. Power and authority of secretary of each department.
(a) Notwithstanding any other provision of this code to the contrary, the secretary of each department shall have plenary power and authority within and for the department to:
(1) Employ and discharge within the office of the secretary employees as may be necessary to carry out the functions of the secretary, which employees shall serve at the will and pleasure of the secretary;
(2) Cause the various agencies and boards to be operated effectively, efficiently and economically and develop goals, objectives, policies and plans that are necessary or desirable for the effective, efficient and economical operation of the department;
(3) Eliminate or consolidate positions, other than positions of administrators or positions of board members and name a person to fill more than one position;
(4) Transfer permanent state employees between departments in accordance with the provisions of section seven of this article;
(5) Delegate, assign, transfer or combine responsibilities or duties to or among employees, other than administrators or board members;
(6) Reorganize internal functions or operations;
(7) Formulate comprehensive budgets for consideration by the Governor, and transfer within the department funds appropriated to the various agencies of the department which are not expended due to cost savings resulting from the implementation of the provisions of this chapter: Provided, That no more than twenty-five percent of the funds appropriated to any one agency or board may be transferred to other agencies or boards within the department: Provided, however, That no funds may be transferred from a special revenue account, dedicated account, capital expenditure account or any other account or funds specifically exempted by the Legislature from transfer, except that the use of appropriations from the State Road Fund transferred to the office of the Secretary of the Department of Transportation is not a use other than the purpose for which the funds were dedicated and is permitted: Provided further, That if the Legislature by subsequent enactment consolidates agencies, boards or functions, the appropriate secretary may transfer the funds formerly appropriated to the agency, board or function in order to implement consolidation. The authority to transfer funds under this section shall expire on the thirtieth day of June, two thousand five; June 30, 2010;
(8) Enter into contracts or agreements requiring the expenditure of public funds, and authorize the expenditure or obligation of public funds as authorized by law: Provided, That the powers granted to the secretary to enter into contracts or agreements and to make expenditures or obligations of public funds under this provision shall not exceed or be interpreted as authority to exceed the powers granted by the Legislature to the various commissioners, directors or board members of the various departments, agencies or boards that comprise and are incorporated into each secretary's department under this chapter;
(9) Acquire by lease or purchase property of whatever kind or character and convey or dispose of any property of whatever kind or character as authorized by law: Provided, That the powers granted to the secretary to lease, purchase, convey or dispose of such property shall be exercised in accordance with the provisions of articles three, ten and eleven, chapter five-a of this code: Provided, however, That the powers granted to the secretary to lease, purchase, convey or dispose of such property shall not exceed or be interpreted as authority to exceed the powers granted by the Legislature to the various commissioners, directors or board members of the various departments, agencies or boards that comprise and are incorporated into each secretary's department under this chapter;
(10) Conduct internal audits;
(11) Supervise internal management;
(12) Promulgate rules, as defined in section two, article one, chapter twenty-nine-a of this code, to implement and make effective the powers, authority and duties granted and imposed by the provisions of this chapter in accordance with the provisions of chapter twenty-nine-a of this code;
(13) Grant or withhold written consent to the proposal of any rule, as defined in section two, article one, chapter twenty-nine-a of this code, by any administrator, agency or board within the department. Without written consent, no proposal for a rule shall have any force or effect;
(14) Delegate to administrators the duties of the secretary as the secretary may deem appropriate, from time to time, to facilitate execution of the powers, authority and duties delegated to the secretary; and
(15) Take any other action involving or relating to internal management not otherwise prohibited by law.
(b) The secretaries of the departments hereby created shall engage in a comprehensive review of the practices, policies and operations of the agencies and boards within their departments to determine the feasibility of cost reductions and increased efficiency which may be achieved therein, including, but not limited to, the following:
(1) The elimination, reduction and restriction of the state's vehicle or other transportation fleet;
(2) The elimination, reduction and restriction of state government publications, including annual reports, informational materials and promotional materials;
(3) The termination or rectification of terms contained in lease agreements between the state and private sector for offices, equipment and services;
(4) The adoption of appropriate systems for accounting, including consideration of an accrual basis financial accounting and reporting system;
(5) The adoption of revised procurement practices to facilitate cost-effective purchasing procedures, including consideration of means by which domestic businesses may be assisted to compete for state government purchases; and
(6) The computerization of the functions of the state agencies and boards.
(c) Notwithstanding the provisions of subsections (a) and (b) of this section, none of the powers granted to the secretaries herein shall be exercised by the secretary if to do so would violate or be inconsistent with the provisions of any federal law or regulation, any federal-state program or federally delegated program or jeopardize the approval, existence or funding of any program.
(d) The layoff and recall rights of employees within the classified service of the state as provided in subsections (5) and (6), section ten, article six, chapter twenty-nine of this code shall be limited to the organizational unit within the agency or board and within the occupational group established by the classification and compensation plan for the classified service of the agency or board in which the employee was employed prior to the agency or board's transfer or incorporation into the department: Provided, That the employee shall possess the qualifications established for the job class. The duration of recall rights provided in this subsection shall be limited to two years or the length of tenure, whichever is less. Except as provided in this subsection, nothing contained in this section shall be construed to abridge the rights of employees within the classified service of the state as provided in sections ten and ten-a, article six, chapter twenty-nine of this code.
(e) Notwithstanding any other provision of this code to the contrary, the secretary of each department with authority over programs which have an impact on the delivery of health care services in the state or are payors for health care services or, are payors for prescription drugs, including, but not limited to, the Public Employees Insurance Agency, the Department of Health and Human Resources, the Bureau for Senior Services, the Children's Health Insurance Program, the Health Care Authority, the Office of the Insurance Commissioner, the Division of Corrections, the Division of Juvenile Services, the Regional Jail and Correctional Facility Authority, the Workers' Compensation Fund, state colleges and universities, public hospitals, state or local institutions including nursing homes and veterans' homes, the Division of Rehabilitation, public health departments, the Bureau for Medical Services and other programs, which have an impact on the delivery of health care services, or are payors for health care services or that are payors for prescription drugs, in West Virginia shall cooperate with the Office of the Pharmaceutical Advocate Governor's Office of Health Enhancement and Lifestyle Planning established pursuant to section four, article sixteen-d, chapter five article twenty-nine-h, chapter sixteen of this code for the purpose of purchasing prescription drugs improving the health care delivery services in West Virginia for any program over which they have authority
: Provided, That no action of Governor's Office of Health Enhancement and Lifestyle Planning shall encumber greater than five percent of the state share of the annual funds appropriated to any one agency or board without prior approval of the secretary with authority over that office.
CHAPTER 16. PUBLIC HEALTH

ARTICLE 2J. PREVENTIVE CARE PILOT PROGRAM.
16-2J-2. Definitions.
For the purposes of this article, the following definitions apply:
(1) "Dependent" has the same meaning set forth in subsection (d), section one-a, article sixteen, chapter thirty-three of this code;
(2) "Family" means a subscriber and his or her dependents;(3) "Medical home" means a team approach to providing health care and care management. Whether involving a primary care provider, specialist or sub-specialist, care management includes the development of a plan of care, the determination of the outcomes desired, facilitation and navigation of the health care system, provision of follow-up and support for achieving the identified outcomes. The medical home maintains a centralized, comprehensive record of all health related services to provide continuity of care;
(4) (3) "Participating provider" means a provider under this article that has been granted a license under this article to operate as part of the pilot program;
(4) "Patient-centered medical home" means a health care setting that facilitates partnerships between individual patients and their personal physicians and, when appropriate, the patients' families and communities. A patient-centered medical home integrates patients as active participants in their own health and well being. Patients are cared for by a physician or physician practice that leads a multidisciplinary health team, which may include, but is not limited, to nurse practitioners, nurses, physician's assistants, behavioral health providers, pharmacists, social workers, physical therapists, dental and eye care providers and dieticians to meet the needs of the patient in all aspects of preventive, acute, chronic care and end-of-life care using evidence-based medicine and technology.
(5) "Primary care" means basic or general health care which emphasizes the point when the patient first seeks assistance from the medical care system and the care of the simpler and more common illnesses;
(6) "Provider" has the same meaning as "ambulatory health care facility" set forth in subsection (b), section two, article two-d of this chapter or "private office practice" as set forth in subdivision (1), subsection (a)(1), section four of said article;
(7) "Qualifying event" means loss of coverage due to: (i) Emancipation and resultant loss of coverage under a parent or guardian's plan; (ii) divorce and loss of coverage under the former spouse's plan; (iii) termination of employment and resultant loss of coverage under an employer group plan: Provided, That any rights of coverage under a COBRA continuation plan as that term is defined in section three-m, article sixteen, chapter thirty-three of this code, shall not be considered coverage under an employer group health plan; (iv) involuntary termination of coverage under a group health benefit plan except for termination due to nonpayment of premiums or fraud by the insured; or (v) exhaustion of COBRA benefits;
(8) "Subscriber" means any individual who subscribes to a prepaid program approved and operated in accordance with the provisions of this article, including an employee of any employer that has purchased a group enrollment on behalf of its employees.
ARTICLE 2L. PATIENT-CENTERED MEDICAL HOMES.
§16-2L-1. Legislative findings.
The Legislature finds that:
(1) There is a need in the state to transform the health care services delivery model toward primary prevention and more proactive care management through the development of patient centered medical homes;
(2) The concept of a patient-centered medical home would promote a partnership between the individual patient, the patients' various health care providers, the patients' family and, if necessary, the community. It integrates the patient as an active participant in their own health and well being;
(3) The patient-centered medical home provides care through a multidisciplinary health team consisting of physicians, nurse practitioners, nurses, physicians assistants, behavioral health providers, pharmacists, social workers, physical therapists, dental and eye care providers and dieticians to meet the health care needs of a patient in all aspects of preventative, acute, chronic, and end-of-life care using evidence based medicine and technology;
(4) In a patient-centered medical home each patient has an ongoing relationship with a personal physician. The physician would lead a team of health care providers who take responsibility for the care of the patient or for arranging care with other qualified professionals;
(5) Transitioning health care delivery services to a patient- centered medical home would provide greater quality of care, increase patient safety and ensure greater access to health care;
(6) Currently there are medical home pilot projects underway at the Bureau for Medical Services and the Public Employees Insurance Agency that should be reviewed and evaluated for efficiency and a means to expand these to greater segments of the state's population, most importantly the uninsured.
§16-2L-2. Definition of a patient-centered medical home.

The patient-centered medical home is a health care setting that facilitates partnerships between individual patients and their personal physicians and, when appropriate, the patients' families and communities. A patient-centered medical home integrates patients as active participants in their own health and well being. Patients are cared for by a physician or physician practice that leads a multidisciplinary health team, which may include but is not limited to nurse practitioners, nurses, physician's assistants, behavioral health providers, pharmacists, social workers, physical therapists, dental and eye care providers and dieticians to meet the needs of the patient in all aspects of preventive, acute, chronic care and end-of-life care using evidence based medicine and technology.
§16-2L-3. Authorization of patient-centered medical home pilot projects; types of pilot projects.

(a) The Governor's Office of Health Enhancement and Lifestyle Planning, as set forth in article twenty-nine-h of this chapter, shall consult with the Bureau for Medical Services and the Public Employee Insurance Agency on current medical home pilot projects which they are operating for their membership population. The director shall evaluate these programs in consultation with the Commissioner of the Bureau for Medical Services and the Director of the Public Employees Insurance Agency for a means to expand these beyond the populations currently being served by these pilots. Once data is available on these pilots that can be reviewed for planning purposes, the director shall utilize this as a means to develop and implement additional patient-centered medical home pilot programs beyond the limited populations served by the Bureau for Medical Services and the Public Employee Insurance Agency. The director shall develop four varying types of patient-centered medical home
pilots based upon experience gained from the projects currently in operation at the Bureau for Medical Services and the Public Employees Insurance Agency. These patient centered medical homes shall be based upon the individual practices of physicians. (b) The four types of pilot programs shall be:
(1) Chronic Care Model Pilots. -- This model shall focus on smaller physician practices. Primary care providers shall work with payers and providers to identify various disease states. Through the collaborative effort of the primary care provider and the payers and providers, programs shall be developed to improve management of agreed-upon conditions of the patient. Through this model, the primary care provider may utilize current practices of multipayer workgroups. These groups shall be comprised of the medical directors of the major health care payers and the state payers along with medical providers and others.
(2) Individual Medical Homes Pilots. -- These pilots shall focus on larger physician practices. They shall seek certification from the National Committee on Quality Assurance. That initial certification will be Level I certification. This would be granted by virtue of certifying the provider is in the process of attainting certification and currently have met provisional standards as set by the National Committee on Quality Assurance. This provisional certification lasts only one year with no renewal.
(3) Community-Centered Medical Home Pilots. -- This approach shall link primary care practices with community health teams which would grow out of the current structure in place for federally qualified health centers. The community health teams shall include social and mental health workers, nurse practitioners, care coordinators and community health workers. These personnel largely exist in community hospitals, home health agencies and other settings. These pilots shall identify these resources as a separate team to collaborate with the primary care practices. The teams would focus on primary prevention such as smoking cessation programs and wellness interventions as well as working with the primary care practices to manage patients with multiple chronic conditions. Within this pilot all health care agencies are connected and share resources. Citizens can enter the system of care from any point and receive the most appropriate level of care or be directed to the most appropriate care. Any financial incentives in this model would involve all health care payers and could be used to encourage collaboration between primary care practices and the community health teams.
(4) Medical Homes for the Uninsured Pilots. -- These pilots shall focus on medical homes to serve the uninsured. They shall include various means of providing care to the uninsured with primary and preventative care. Through this mechanism, a variety of pilots may be developed that shall include screening, treatment of chronic disease and other aspects of primary care and prevention services. The pilots will be chosen based on their design meeting the requirements of this subsection and the resources available to provide these services.
§16-2L-4. Rule-making authority.
The Governor's Office of Health Enhancement and Lifestyle Planning shall propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code as necessary to implement the provisions of this article. The Governor's Office of Health Enhancement and Lifestyle Planning may also promulgate emergency rules pursuant to the provisions of section fifteen, article three, chapter twenty-nine-a of this code if they deem them necessary.
§16-2L-5. Guidelines for evaluation of the pilot program; report to Legislative Oversight Commission on Health and Human Resources Accountability.

(a) The Governor's Office of Health Enhancement and Lifestyle Planning shall establish by guidelines, criteria to evaluate the pilot program and may require participating providers to submit such data and other information related to the pilot program as may be required by the Governor's Office of Health Enhancement and Lifestyle Planning. For purposes of this article, this information shall be exempt from disclosure under the Freedom of Information Act in article one, chapter twenty-nine-b of this code.
(b) No later than December 1, 2009, and annually thereafter during the operation of the pilot program, the Governor's Office of Health Enhancement and Lifestyle Planning must submit a report to the Legislative Oversight Commission of Health and Human Resources Accountability as established in article twenty-nine-e of this chapter on progress made by the pilot project including suggested legislation, necessary changes to the pilot program and suggested expansion of the pilot program.
ARTICLE 29H. GOVERNOR'S OFFICE OF HEALTH ENHANCEMENT AND LIFESTYLE PLANNING.

§16-29H-1. Legislative findings.
The Legislature finds:
(1) Rising health care costs have a significant impact not only on the citizens of the state but is also impacting the state's ability to develop a competitive advantage in seeking new business. Reducing this level of costs and developing new, more effective options for reducing growth in health care spending is essential to ensuring the health of West Virginia's citizens and to the advancement of a well developed workforce.
(2) West Virginia spends thirteen percent more per person on health care than the national average. Moreover, the growth in spending in the state is higher than the national average. These rising costs have contributed to fewer employers, particularly small employers, offering health insurance as a benefit of employment. This is an occurrence that may further drive up health care costs throughout the state.
(3) West Virginia is among the highest in such health care indicators as childhood and adult obesity which provides a direct connection to higher rates of diabetes, hypertension, hyperlipidemia, heart disease, pulmonary disorders and comorbid depression experienced in West Virginia. Nearly one third of the rise in health care costs can be attributed to the rise in obesity throughout the state and the nation. Additionally, high rates of chronic illness represents a substantial reduction in worker productivity.
(4) To address the concerns over rising costs, West Virginia must change the way it pays for care, shifting the focus to primary care and prevention. Seventy-five percent of health care spending is associated with treatment of chronic diseases requiring on-going medical management over time. Patients with chronic diseases, however, only receive fifty-six percent of the clinically recommended preventive services. This lack of preventive services creates a seventy-five percent increase in health care spending.
(5) Health care delivery in West Virginia needs to be modernized. This will require substantial changes in how health care is delivered to the chronically ill, an increase in information technology tools used for patient management, a simplification of health care processing and a broad overhaul in our perceptions of wellness and prevention.
(6) West Virginians must be challenged to engage in a more healthy lifestyle, they must alter the focus of their perception of health care from one of episodic care to prevention and wellness efforts. Equally as important is that healthcare providers must be engaged with their patients and in the process of delivery of health care and strive for continuous improvement of the quality of care they provide.
(7) West Virginia must develop a health care system that is sufficient to meet the needs of its citizens; equitable, fair and sustainable but that is also accountable for quality, access, cost containment and service delivery.
§16-29H-2. Definitions.
In this article:
(1)
"Advertising or marketing" means to make publically and generally known information, paid for by sponsors through various print or broadcast media or persons, intended to persuade consumers to purchase products, services or ideas related to pharmaceuticals .
(2)
"Audit" means a formal and systematic examination and collection of information by an independent certified public accountant necessary to attest to the fairness and accuracy of the funds expended in a fiscal year pursuant to a prescription drug purchasing agreement or a pharmacy benefit management contract.
(3) "Director" means the position created pursuant to section four of this article.
(4) "Drug manufacturer" or "pharmaceutical manufacturer" means an entity engaged in: (A) The production, preparation, propagation, compounding, conversion or processing of prescription drug products by extraction from substances of natural origin, or independently by means of chemical synthesis or by a combination of extraction and chemical synthesis; or (B) in the packaging, repackaging, labeling, relabeling or distribution of prescription drug products. "Drug manufacturer" or "pharmaceutical manufacturer" does not include a wholesale distributor of drugs or a retail pharmacy licensed under state law.
(5) "Governor's Office of Health Enhancement and Lifestyle Planning" or "office" means the office created pursuant to section three of this article.
(6) "Health care delivery services" means any state provided service aimed at prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions. For the purposes of this article, health care delivery services includes the payment for such services by a state entity.
(7) "Health Care Delivery Service Agreements or Prescription drug purchasing agreement" means a written agreement to pool all parties' buying power in order to negotiate the best possible prices.
(8) "Health Enhancement and Lifestyle Planning Advisory Council" or "advisory council" means the Council created pursuant to section twelve of this article.
(9) "Labeler" means an entity or person that has a labeler code from the Food and Drug Administration pursuant to 21 C. F. R. §207.20 (1999) and receives prescription drugs from a manufacturer or wholesaler and repackages those drugs for later retail sale.
(10) "Person" means any natural person or persons or any corporation, partnership, company, trust or association of persons.
(11) "Prescription drugs" mean substances recognized as drugs in the official "United States Pharmacopoeia, Official Homeopathic Pharmacopoeia of the United States or National Formulary", or any supplement thereto, dispensed pursuant to a prescription issued by an authorized health care practitioner for use in the diagnosis, cure, mitigation, treatment or prevention of disease in a human, as well as prescription drug delivery systems, testing kits and related supplies.
§16-29H-3. Creation of the Governor's Office of Health Enhancement and Lifestyle Planning; duties.
(a) There is created the Governor's Office of Health Enhancement and Lifestyle Planning. The purpose of this office is to coordinate all state health care system reform initiatives among executive branch agencies, departments, bureaus and offices. The office shall be under the direct supervision of the director, who is responsible for the exercise of the duties and powers assigned to the office under the provisions of this article.
(b) All state agencies that have responsibility for the development, improvement and implementation of any aspect of West Virginia's health care system, including, but not limited to, the Public Employees Insurance Agency, the Bureau for Senior Services, the Children's Health Insurance Program, the Health Care Authority, the Insurance Commission, the Department of Health and Human Resources, state colleges and universities, public hospitals, state or local institutions such as nursing homes, veteran's homes, the Division of Rehabilitation and public health departments, shall cooperate with the Governor's Office of Health Enhancement and Lifestyle Planning established for the purpose of coordinating the health care delivery system in West Virginia for any program over which they have authority: Provided, That no action of Governor's Office of Health Enhancement and Lifestyle Planning shall encumber greater than five percent of the state share of the annual funds appropriated to any one agency or board without prior approval of the secretary with authority over that office.
§16-29H-4. Director of the Governor's Office of Health Enhancement and Lifestyle Planning appointment; qualifications; oath; salary.

(a) The office is under the supervision of the director. The director is the executive and administrative head of the office and shall be appointed by the Governor with advice and consent of the Senate. The director shall be qualified by training and experience to direct the operations of the Governor's Office of Health Enhancement and Lifestyle, and serves at the will and pleasure of the Governor. The duties of the director include, but are not limited to, the management and administration of the Governor's Office of Health Enhancement and Lifestyle.
(b) The director:
(1) Serves on a full-time basis and may not be engaged in any other profession or occupation;
(2) May not hold political office in the government of the state either by election or appointment while serving as the Director;
(3) Shall be a citizen of the United States and become a resident of the state within ninety days of appointment;
(4) Is entitled to receive an annual salary as provided by the Governor; and
(5) Is ineligible for civil service coverage as provided in section four, article six, chapter twenty-nine of this code. Any other employee hired by the director is also ineligible for civil service coverage.
(c) Before entering upon the discharge of the duties as director, the director shall take and subscribe to the oath of office prescribed in section five, article IV of the Constitution of West Virginia. The executed oath shall be filed in the Office of the Secretary of State.
§16-29H-5. Director of the Governor's Office of Health Enhancement and Lifestyle; powers and duties, hiring of staff.
(a) The director has the power and authority to:
(1) Purchase or enter into contracts or agreements as necessary to achieve the purposes of this article;
(2) File suit;
(3) Evaluate and renegotiate existing contracts for state purchase necessary for health care delivery services, including pharmaceuticals. In renegotiating existing contracts, the director shall include the secretary, or his or her designee, of the department which is the subject of the contract in all negotiations;
(4) Negotiate and execute pharmacy benefit management contracts for the purpose of managing rising costs for this state and all parties which have executed prescription drug purchasing agreements;
(5) Make recommendations to the Governor and the Legislature regarding strategies that could more effectively make the health care delivery system in West Virginia more timely, more patient-centered, provide greater patient access and quality of service and control health care costs;
(6) Assume previous duties assigned to the Pharmaceutical Cost Management Council set forth in section eight, article three-c, chapter five-a of this code. This shall include:
(i) To ensure disclosure by drug manufacturers and labelers of expenditures for marketing, advertising and promotional costs in accordance with the provisions of section fifteen of this article;
(ii) To make recommendations to the Governor and the Legislature regarding strategies that could more effectively control the costs of prescription drugs in West Virginia;
(iii) To issue grants to achieve the goals of this article, including the initiation, evaluation and promotion of strategies that may result in reduced costs of prescription drugs; and
(iv) To evaluate, develop and implement other programs, projects and initiatives to achieve the purposes of this article, including, but not limited to, a streamlined prior authorization process for state insurers and patient assistance programs in their current forms, as well as new programs such as central fill pharmacy/bulk replenishment models.
(7) Develop and implement other programs, projects and initiatives to achieve the purposes of this article, including initiating, evaluating and promoting other strategies that result in greater access to health care, assure greater quality of care and result in reduced costs for health care delivery services to the citizens of West Virginia, and
(8) Develop a five-year strategic plan as set forth in section five of this article for implementation of West Virginia's health care system reform initiatives together with recommendations for administration, policy, legislative rules or legislation. This plan shall be reported to the Joint Committee on Government and Finance, the Legislative Oversight Commission on Health and Human Resources Accountability and the Governor on or before December 31, 2009.
(b) The director shall employ such professional, clerical, technical and administrative personnel as may be necessary to carry out the provisions of this article.
(c) The director shall prepare and submit to the Governor and the Legislature annual proposed appropriations for the next fiscal year which shall include sums necessary to support the activities of the Governor's Office of Health Enhancement and Lifestyle.
(d) The director shall submit an annual report separate from the strategic plan by January 1 of each year to the Governor and the Legislative Oversight Commission on Health and Human Resources Accountability on the condition, operation and functioning of the Governor's Office of Health Enhancement and Lifestyle Planning.
(e) The director shall supervise the fiscal management and responsibilities of the Office of Health System Improvement.
(f) The director shall keep an accurate and complete record of all the Governor's Office of Health Enhancement and Lifestyle proceedings, records and file all bonds and contracts and assume responsibility for the custody and preservation of all papers and records of the office.
(g) The director shall convene a series of focus groups, polls and any other available research tool to determine issues of importance to all stakeholders. The development of these survey tools shall be done in conjunction with employers, health care providers and consumers. Data received from this research should be easily available to the public and utilized in the development and design of health benefit programs. The data should also be accessible to providers to allow them to meet the needs of the health care market.
(h) The director may propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code to accomplish the goals and purposes of this article.
§16-29H-6. Authorization to execute health care delivery service agreements and prescription drug purchasing agreements.

(a) The director may execute, subject to the provisions of subsection (b) of this section and as permitted by applicable federal law, health care delivery service agreements and prescription drug purchasing agreements with:
(1) All departments, agencies, authorities, institutions, programs, quasi-public corporations and political subdivisions of this state, including, but not limited to, the Department of Health and Human Resources, the Public Employee's Insurance Agency, the Children's Health Insurance Program, the Division of Corrections, the Division of Juvenile Services, the Regional Jail and Correctional Facility Authority, state colleges and universities, state medical schools and the school of osteopathy, public hospitals, state or local institutions such as nursing homes, veterans' homes, the West Virginia State Police, the Division of Rehabilitation, public health departments and the Bureau of Medical Services: Provided, That any contract or agreement executed with or on behalf of the Bureau of Medical Services shall contain all necessary provisions to comply with the provisions of Title XIX of the Social Security Act, 42 U. S. C. §1396, et seq., dealing with pharmacy services offered to recipients under the medical assistance plan of West Virginia;
(2) Governments of other states and jurisdictions and their individual departments, agencies, authorities, institutions, programs, quasi-public corporations and political subdivisions; (3) Regional or multistate purchasing alliances or consortia, formed for the purpose of pooling the combined purchasing power of the individual members in order to increase bargaining power; and (4) Arrangements with entities in the private sector, including, commercial insurance carriers, self-funded benefit plans and private and not-for-profit health care organizations toward combined purchasing of health care services, health care management services, pharmacy benefits management services or pharmaceutical products: Provided, That no private entity may be compelled to participate.
(b) The advisory council created pursuant to section ten of this article is responsible for reviewing any proposed contract authorized by this article before it is executed by the director. If the advisory council determines that the proposed contract meets the requirements of this article and would assist in effectively managing the costs for the programs involved and would not result in jeopardizing state funds or funds due the state, it shall recommend to the director to execute the contract.
(c) The advisory council may not recommend, and the director may not execute, any agreement that does not effectively and efficiently manage rising health care or drug costs on behalf of the parties to the agreement.
(d) The advisory council may not recommend, and the director may not execute, any agreement that grants the state's credit for the purchase of health care services or prescription drugs by any entity other than this state.
§16-29H-7. Audit required; reports.

(a) The director shall require an audit be conducted of any funds expended pursuant to any health care delivery service or prescription drug purchasing agreement or pharmacy benefit management contract executed under the provisions of this article for each fiscal year that the agreement or contract is in effect. The director shall submit the audit to the Joint Committee on Government and Finance and the Legislative Oversight Commission on Health and Human Resources Accountability upon completion, but in no event later than December 31 after the end of the fiscal year subject to the audit.
(b) The director shall provide written notice to the Joint Committee on Government and Finance prior to executing an agreement or a contract or amending an existing contract.
§16-29H-8. Authorization to execute contracts.

The director may negotiate and execute contracts for the purpose of managing rising health care and drug costs for this state and all parties which have executed health care delivery
service or prescription drug purchasing agreements with the state or any state agency, including, but not limited to, the Department of Health and Human Resources, the Public Employees Insurance Agency, the Children's Health Insurance Program, the Health Care Authority, the Office of the Insurance Commissioner, the Division of Corrections, the Division of Juvenile Services, the Regional Jail and Correctional Facility Authority, state colleges and universities, state medical schools and the school of osteopathy, public hospitals, state or local institutions such as nursing homes, veterans' homes, the West Virginia State Police, the Division of Rehabilitation, public health departments and the Bureau of Medical Services or other programs which are providers of services that impact health care delivery in West Virginia.
§16-29H-9. Authorization to amend existing contracts.
The director may renegotiate and amend contracts to which the state or any state agency, including, but not limited to, the Department of Health and Human Resources, the Public Employees Insurance Agency, the Children's Health Insurance Program, the Health Care Authority, the Office of the Insurance Commissioner, the Division of Corrections, the Division of Juvenile Services, the Regional Jail and Correctional Facility Authority, state colleges and universities, state medical schools and the school of osteopathy, public hospitals, state or local institutions such as nursing homes, veterans' homes, the West Virginia State Police, the Division of Rehabilitation, public health departments and the Bureau of Medical Services, or other programs which have an impact on health care delivery services in West Virginia is a party for the purpose of managing rising health care costs.
In renegotiating existing contracts, the director shall include the secretary, or his or her designee, of the department which is the subject of the contract in all negotiations.
§16-29H-10. Multistate alliances or consortia; discussion groups; agreements.

(a) The director may
participate in a cooperative purchasing agreement, alliance or consortium for the purchase of prescription drugs with agencies of other states, other public bodies, or other state agencies, if available and financially advantageous. Nothing in this article shall prohibit the payment of any administrative fee necessary to participate in such a cooperative purchasing agreement, alliance, or consortium.
(b) If the director participates in any cooperative purchasing agreement, alliance, or consortium which is comprised of at least five million covered lives, the cooperative purchasing agreement, alliance or consortium may employ either the federal supply schedule or an agreed-upon pricing schedule that, in the judgment of the advocate and the other participating entities, will maximize savings to the broadest percentage of the population of this state: Provided, That any pharmaceutical manufacturer that deals with such cooperative purchasing agreements, alliances, or consortia may request a waiver from such pricing schedule in West Virginia for a particular drug that should be granted if the advocate finds that the
development, production, distribution costs, other reasonable costs and reasonable profits excluding marketing, advertising and promotional costs not essential to bringing the product to market are more than the schedule price of the pharmaceutical or in those cases in which the pharmaceutical in question has a sole source . The director shall determine fees to be paid by the applicant at the time of the waiver application and proof required to be submitted at the time of the waiver request to support the validity of the request.
§16-29H-11. Exemption from Purchasing Division requirements.
The provisions of article three, chapter five-a of this code do not apply to the agreements and contracts executed under the provisions of this article, except that the contracts and agreements shall be approved as to form and conformity with applicable law by the Attorney General.
§16-29H-12. Creation of the Health Enhancement and Lifestyle Planning Advisory Council.

(a) The Health Enhancement and Lifestyle Planning Advisory Council is hereby created. The advisory council is an independent, self-sustaining council that has the powers and duties specified in this article.
(b) The advisory council is a part-time council whose members perform such duties as specified in this article. The ministerial duties of the advisory council shall be administered and carried out by the Governor's Office of Health Enhancement and Lifestyle Planning.
(c) Each member of the advisory council shall devote the time necessary to carry out the duties and obligations of the office. Those members appointed by the Governor may pursue and engage in another business or occupation or gainful employment that is not in conflict with the duties of the advisory council.
(d) The advisory council is self-sustaining and independent, however, it, its members, the director and employees of the Governor's Office of Health Enhancement and Lifestyle Planning are subject to article nine-a of chapter six, chapter six-b, chapter twenty-nine-a and chapter twenty-nine-b of this code.
§16-29H-13. Appointment of members of the Health Enhancement and Lifestyle Planning Advisory Council; chairperson; qualifications and eligibility; reimbursement for expenses.

(a) The advisory council is comprised of the following governmental officials: The Secretary of the Department of Health and Human Resources, or his or her designee, the Director of the Public Employees Insurance Agency, or his or her designee, the Commissioner of the Office of the Insurance Commissioner, or his or her designee, the Chair of the West Virginia Health Care Authority, or his or her designee. The council shall also consist of the following public members: one public member shall represent an organization of senior citizens with at least ten thousand members within the state, one public member shall represent the interest of family practice physicians or primary care physician, one public member shall represent the West Virginia Chamber of Commerce, one public member shall represent the largest education employee organization in the state, one public member shall represent the largest labor organization in the state, one public member shall represent West Virginia Hospital Association, one public member shall represent the West Virginia Medical Association and two ex- officio nonvoting members shall be the Speaker of the House, or his or her designee, and the President of the Senate, or his or her designee.
(b) Public members shall be appointed by the Governor with advice and consent of the Senate. Each public member shall serve for a term of four years. Of the public members of the advisory council first appointed, one shall be appointed for a term ending June 30, 2010, and two each for terms of three and four years. Each public member serves until his or her successor is appointed and has qualified. The Director of the Governor's Office of Health Enhancement and Lifestyle Planning shall serve as chairperson of the advisory council.
(c) Advisory Council members may not be compensated in their capacity as members but shall be reimbursed for reasonable expenses incurred in the performance of their duties.
§16-29H-14. Meeting requirements.
(a) The advisory council shall meet within the state at such times as the chair may decide, but at least once annually. The advisory council shall also meet upon a call of seven or more members upon seventy-two hours written notice to each member.
(b) Seven members of the advisory council are a quorum for the transaction of any business.
(c) A majority vote of the members present is required for any final determination by the advisory council. Voting by proxy is not allowed.
(d) The advisory council shall keep a complete and accurate record of all its meetings according to section five, article nine-a, chapter six of this code.
§16-29H-15. Removal of advisory council members.
Notwithstanding the provisions of section four, article six, chapter six of this code, the Governor may remove any advisory council member for incompetence, misconduct, gross immorality, misfeasance, malfeasance or nonfeasance in office.
§16-29H-16. General duties of the Health Enhancement Lifestyle Advisory Council.

The advisory council has general responsibility to review and provide advice and comment to the Governor's Office of Health Enhancement and Lifestyle Planning on its policies and procedures relating to the delivery of health care services or the purchase of prescription drugs. The advisory council shall offer advice to the Director on matters over which the office has authority and oversight. This includes, but is not limited to:
(1) Hiring of professional, clerical, technical and administrative personnel as may be necessary to carry out the provisions of this article;
(2) Contracts or agreements;
(3) Rule-making authority; and
(4) Development of policy necessary to meet the duties and responsibilities of the Governor's Office of Health Enhancement and Lifestyle Planning pursuant to the provisions of this article.
§16-29H-17. Advertising costs; reporting of same.
(a) The rule-making authority previously granted to the Pharmaceutical Cost Management Council in article three-c, chapter five-a of this code to require the reporting of pharmaceutical advertising costs is here transferred to the Governor's Office of Health Enhancement and Lifestyle Planning.
(b) Advertising costs for prescription drugs, based on aggregate national data, shall be reported to the Governor's Office of Health Enhancement and Lifestyle Planning by all manufacturers and labelers of prescription drugs dispensed in this state that employs, directs or utilizes marketing representatives. The reporting shall assist this state in its role as a purchaser of prescription drugs and an administrator of prescription drug programs, enabling this state to determine the scope of prescription drug advertising costs and their effect on the cost, utilization and delivery of health care services and furthering the role of this state as guardian of the public interest. (c) The Governor's Office of Health Enhancement and Lifestyle Planning shall establish by legislative rule pursuant to the provisions of article three, chapter twenty-nine-a of this code the reporting requirements of information by labelers and manufacturers which shall include all national aggregate expenses associated with advertising and direct promotion of prescription drugs through radio, television, magazines, newspapers, direct mail and telephone communications as they pertain to residents of this state.
(d) The following are exempt from disclosure requirements: (1) All free samples of prescription drugs intended to be distributed to patients;
(2) All marketing items of a value less than one hundred dollars;
(3) All payments of reasonable compensation and reimbursement of expenses in connection with a bona fide clinical trial. As used in this subdivision, "clinical trial" means an approved clinical trial conducted in connection with a research study designed to answer specific questions about vaccines, new therapies or new ways of using known treatments;
(4) All scholarship or other support for medical students, residents and fellows to attend significant educational, scientific or policy-making conference of national, regional or specialty medical or other professional association if the recipient of the scholarship or other support is selected by the association; and
(5) Any data that identifies specific prescription drugs or pharmaceuticals by individual name, any group of individuals or specific individual by name and any specific physician or pharmacy or group of physicians or pharmacies by name.
(e) The Governor's Office of Health Enhancement and Lifestyle Planning is authorized to establish time lines, the documentation, form and manner of reporting required as he or she, with advice of the advisory council, determines necessary to effectuate the purpose of this article. The director shall include in the annual report required pursuant to subsection (d) of section four of this article, in an aggregate form, the information provided in the required reporting.
(f) Notwithstanding any provision of law to the contrary, information submitted to the director pursuant to this section is confidential and is not a public record and is not available for release pursuant to the West Virginia Freedom of Information Act codified in chapter twenty nine-b, article one of this code. Data compiled in aggregate form by the director for the purposes of reporting required by this section is a public record as defined in the West Virginia Freedom of Information Act as long as it does not reveal trade information that is protected by state or federal law or specific prescription drugs or pharmaceuticals by individual name, any group of individuals or specific individual by name and any specific physician or pharmacy or group of physicians or pharmacies by name.
§16-29H-18. State role; authority for participation by all state agencies.

(a) For purpose of implementing this article, the state is represented by the director and he or she has authority to negotiate health care delivery service costs and pharmaceutical prices to be paid by program participants. These negotiated prices shall be available to all programs. (b) The Department of Health and Human Resources, the Public Employees Insurance Agency, the Children's Health Insurance Program, the Health Care Authority, the Office of the Insurance Commissioner, the Division of Corrections, the Division of Juvenile Services, the Regional Jail and Correctional Facility Authority, state colleges and universities, state medical schhols and the school of osteopathy, public hospitals, state or local institutions such as nursing homes, veterans' homes, the West Virginia State Police, the Division of Rehabilitation, public health departments and the Bureau of Medical Services or other programs which are offer health care delivery services or are payors for prescription drugs shall have the authority to participate in any program developed by the Governor's Office of Health Enhancement and Lifestyle Planning.
§16-29H-19. Development of a strategic plan.
The director shall develop a five-year strategic plan for implementation of any and all health care system reform initiatives. These initiatives shall be included, but are not limited to:
(1) Development of pilot projects for patient-centered medical homes as set forth in article two-l of this chapter;
(2) Prioritization of chronic conditions to be targeted for purposes of resource allocation and for greater chronic care management. This should include pilot projects for community based health teams for the development of care plans for healthy children and adults to maintain good health and for at-risk populations to prevent development of preventable chronic diseases;
(3) Development of a single private entity, or no more than three regional entities, in the state to provide centralized practitioner credentialing as set forth in article one-a, chapter sixteen of this code;
(4) Development of standardized prior authorization requirements and processes from insurers;
(5) Implementation of nutrition labeling in restaurants as required by section six, article one-e, chapter five of this code;
(6) Coordination with the State Board of Education as set forth in article two, chapter eighteen of this code to provide for:
(i) The preservation and allocation of recess time away from instruction and separate from physical education classes in the state schools;
(ii) Continuing education for school food personnel and a career hierarchy for food personnel that offers rewards for continuing education hours and credits;
(iii) School based physical education coordinators; and
(iv) Placement of a dietician in each regional education service area throughout the state.
(7) Implementation of school based initiatives to achieve greater dietary consistency in West Virginia's school system and to gain greater physical fitness from students;
(8) Development of community based projects designed for the construction, development and maintenance of bicycle and pedestrian trails and sidewalks;
(9) Development and implementation of universal wellness and health promotion benefits;
(10) Continued promotion and support for efforts to decrease the number of West Virginians using tobacco products;
(11) Any necessary changes that will increase small businesses who offer available health insurance as a benefit of employment;
(12) Development of goals to further improve health care delivery in West Virginia. This should include a means to evaluate progress toward achieving these goals in a simple and timely manner;
(13) Measurement of progress of health care provider and physicians to the adoption and use of electronic medical records in their offices;
(14) Coordination of the health information technology in coordination with the West Virginia Health Information Network which shall include:
(i) Working through the West Virginia Health Information Network, as set forth in article twenty nine-g of this chapter, to develop a single common path for health information exchange;
(ii) Facilitation and encouragement of ongoing projects such as electronic medical record resources in community health clinics;
(iii) Encourage continued development of hospital systems and deployment of hospital-supported electronic medical records when available for hospital-based, hospital-employed and nonhospital-employed physicians;
(iv) Development of strategies to implement tax incentives, vendor discounts, enhanced reimbursement and other means to individual physician offices and clinics to encourage greater adoption and use of electronic medical records;
(v) Develop recommended electronic medical record best practices utilizing the Certification Commission for Health Care Information Technology as the minimum standard; and
(vi) Develop funding mechanisms that provide initial start-up funds and a mechanism for sustainability of electronic medical records that shall be managed by the West Virginia Health Information Network.
§16-29H-20. Rulemaking.
To implement any section of this article, the Office of the Pharmaceutical Director, in consultation with the advisory council, shall propose rules for legislative approval in accordance with article three, chapter twenty-nine-a of this code. This authority shall include emergency rule-making authority pursuant to the provisions of section fifteen, article three, chapter twenty-nine-a of this code. These rules may include, but are not limited to:
(1) Development and implementation of patient centered medical homes pilot projects. This rules shall include a means to evaluate these for expansion.
(2) Development of criteria to establish a purchasing consortium. These criteria should include, but are not limited to, membership eligibility, which shall include state entities that are providers of health care delivery services or are payors for prescription drugs and may include private individuals and commercial insurance carriers; self-funded benefit plans and private and not-for-profit health care providers; consortium operation and functionality and the manner and procedure for the consortium to either bid or negotiate pricing with providers of health care delivery services or pharmaceutical manufacturers for obtaining lower priced pharmaceuticals;
(3) The reporting requirements of information by labelers and manufacturers required pursuant to section fifteen of this article which shall include all national aggregate expenses associated with advertising and direct promotion of prescription drugs through radio, television, magazines, newspapers, direct mail and telephone communications as they pertain to residents of this state;
(4) Development of virtual wholesale program to allow the state to act as a pharmaceutical drug wholesaler and ensure that prices obtained by a buying consortium operated by the director would be made available for purchase by local pharmacies if the pharmaceutical advocate finds it necessary;
(5) Development of a menu labeling program to post caloric content at the point of purchase in national chains; and
(6) Other legislative rules considered necessary by the director to carry out the duties and responsibilities prescribed to the director or the Governor's Office of Health Enhancement and Lifestyle Planning in this article.

§16-29H-21. Coordination with higher education.
The director shall consult with all the colleges and universities in the state, both public and private, with the state's three medical schools and with community and technical colleges. The purpose of this collaboration would be:
(1) The development of curricula focused on a chronic care model to reflect the multidisciplinary team approach to the delivery of health care services in West Virginia as contemplated by the development of a patient centered medical home as that term is defined in section two, article two-j of this chapter; and
(2) The development of technology centered jobs that would further the state's efforts in moving toward the broader use of electronic health records.


NOTE: The purpose of this bill is establish pilot projects to operate various types of patient centered medical homes throughout the state. This bill was recommended for passage during the 2009 Regular Session by Select Committee D on Health.

Strike-throughs indicate language that would be stricken from the present law, and underscoring indicates new language that would be added.


§16-2L is new; therefore, strike-throughs and underscoring have been omitted; §16-29H-6 through 22 are new; therefore, strike- throughs and underscoring have been omitted.

Articles §16-29H-1 through 5 has been substantially rewritten; therefore, strike-throughs and underscoring have been omitted.
This Web site is maintained by the West Virginia Legislature's Office of Reference & Information.  |  Terms of Use  |   Web Administrator   |   © 2014 West Virginia Legislature ***