Senate Bill 414 History
Senate Bill No. 414
(By Senators Prezioso, Foster, Jenkins, Stollings, Caruth, Laird,
Unger, Minard and Kessler)
[Introduced March 2, 2009; referred to the Committee on Health
and Human Resources; and then to the Committee on Finance.]
A BILL to amend and reenact §16-2J-2 of the Code of West Virginia,
1931, as amended; and 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, all relating generally to establishing pilot
projects for patient-centered medical homes; setting forth
legislative findings; defining terms; establishing criteria
for pilot projects for patient-centered medical homes;
defining three types of pilot projects; setting forth
evaluation criteria; and granting rule-making authority.
Be it enacted by the Legislature of West Virginia:
That §16-2J-2 of the Code of West Virginia, 1931, as amended,
be amended and reenacted; and 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,
all to read as follows:
ARTICLE 2J. PREVENTIVE CARE PILOT PROGRAM.
For the purposes of this article, the following definitions
(1) "Dependent" has the same meaning set forth in subsection
(d), section one-a, article sixteen, chapter thirty-three of this
(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
(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
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; and
(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.
§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
§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 develop and implement during the fiscal year beginning July
1, 2009, pilot programs that permit the development of three
varying types of pilots based upon the individual practices of
physicians. These pilot programs will allow operation as a patient
centered medical home.
(b) The three 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.
§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 provision 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.
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
§16-2L is new; therefore, strike-throughs and underscoring
have been omitted.