Senate Bill No. 523
(By Senators Minard, D. Facemire and Kessler)
____________
[Introduced February 10, 2010; referred to the Committee on
Health and Human Resources; and then to the Committee on
Finance.]
____________
A BILL to amend and reenact §9-2-9 of the Code of West Virginia,
1931, as amended, relating to directing the Secretary of the
Department of Health and Human Resources to make
recommendations relating to seeking a Medicaid waiver for
patients with traumatic brain injury.
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 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
is 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)
By July 1, 2010, recommendations relating to seeking a
Medicaid waiver to address the needs of traumatic brain injury
patients within this state;
(13) (14) 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 is 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.
NOTE: The purpose of this bill is to require the Secretary of
the Department of Health and Human Resources to make
recommendations to the Joint Committee on Government and Finance
relating to seeking a Medicaid waiver for traumatic brain injury
patients.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.
Email
Webmaster | © 2024 West Virginia Legislature **
