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

Introduced Version Senate Bill 433 History

   |  Email


sb433 intr
Senate Bill No. 433

(By Senators Tucker and Plymale)

____________

         [Introduced March 5, 2013; referred to the Committee on Government Organization; and then to the Committee on the Judiciary          .]                            

____________




A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §27-1A-12, relating to creating an informal dispute resolution process available to providers or licensees of the Department of Health and Human Resources.
Be it enacted by the Legislature of West Virginia:
    That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new section, designated §27-1A-12, to read as follows:
ARTICLE 1A. DEPARTMENT OF HEALTH.
§27-1A-12.
Informal Dispute Resolution.
     (a) A provider of behavioral health services or a licensee adversely affected by an order or citation of a deficient practice issued pursuant to this article or pursuant to federal law may request to use the independent informal dispute resolution process. A provider or licensee may contest a cited deficiency as contrary to rule, regulation or law or unwarranted by the facts.
     (b) The secretary shall establish a panel of at least three approved independent review providers. The secretary shall contract with the independent review providers to conduct the informal dispute resolution processes. Each independent review provider shall be accredited by the Utilization Review Accreditation Commission. When a provider or licensee requests an informal dispute resolution process, the secretary shall choose one independent review provider from the approved panel to conduct the process.
     (c) The independent informal dispute resolution process is not a formal evidentiary proceeding and utilization of the independent informal dispute resolution process does not waive the right of the provider or licensee to request a formal hearing.
     (d) The independent informal dispute resolution process consists of the following:
     (1) The secretary shall transmit to the provider or licensee a statement of deficiencies committed by the provider or licensee and request that the provider or licensee submit a plan of correction addressing the cited deficiencies no later than ten working days following the last day of the survey or inspection, or no later than twenty working days following the last day of a complaint investigation
. Notification of the availability of the independent informal dispute resolution process and an explanation of the independent informal dispute resolution process shall be included in the transmittal.
     (2) When the provider or licensee returns its plan of correction to the secretary, the provider or licensee may request, in writing, to participate in the independent informal dispute resolution process to protest or refuse all or part of the cited deficiencies within ten working days. If only certain citations or the entire report are disputed using the informal dispute resolution process, no plan of correction is required for citations under appeal. The secretary may not release the final report until the appealed citations are resolved.
     (3) The secretary shall refer the request to an independent review provider from the panel of certified independent review providers approved by the department within five working days of receipt of the written request for the independent informal dispute resolution process made by a provider or licensee
. The secretary shall vary the selection of the independent review providers on a rotating basis. The secretary shall acknowledge in writing to the provider or licensee that the request for independent review has been received and forwarded to the independent review provider. The notice shall include the name and address of the independent review provider.
     (4) The independent review provider shall hold an independent informal dispute resolution conference unless additional time is requested by the provider within ten working days of receipt of the written request for the independent informal dispute resolution process made by a provider or licensee
. The provider or licensee may submit additional information before the independent informal dispute resolution conference.
     (5) Neither the secretary nor the provider or licensee may be accompanied by counsel during the independent informal dispute resolution conference. The manner in which the independent informal dispute resolution conference is held is at the discretion of the provider, but is limited to:
     (A) A desk review of written information submitted by the provider or licensee; or
     (B) A telephonic conference; or
     (C) A face-to-face conference held at the location of the provider or licensee or a mutually agreed upon location.
     (6) If the independent review provider determines the need for additional information, clarification or discussion after conclusion of the independent informal dispute resolution conference, the secretary and the provider or licensee shall present the requested information.
     (7) The independent review provider shall make a determination within ten working days of the independent informal dispute resolution conference, based upon the facts and findings presented, and shall transmit a written decision containing the rationale for its determination to the provider or licensee and to the secretary.
     (8) If the secretary disagrees with the determination, the secretary may reject the determination made by the independent review provider and shall issue an order setting forth the rationale for the reversal of the independent review provider's decision to the provider or licensee within ten working days of receiving the independent review provider's determination. The secretary may not assign review of the rejection to a designee.
     (9) If the secretary accepts the determination, the secretary shall issue an order affirming the independent review provider's determination within ten working days of receiving the independent review provider's determination.
     (10) If the independent review provider determines that the original statement of deficiencies should be changed as a result of the independent informal dispute resolution process and the secretary accepts the determination, the secretary shall transmit a revised statement of deficiencies to the provider or licensee within ten working days of the independent review provider's determination.
     (11) The provider or licensee shall submit a revised plan to correct any remaining deficiencies to the secretary within ten working days of receipt of the secretary's order and the revised statement of deficiencies.
     (e) Under the following circumstances, the provider or licensee is responsible for certain costs of the independent information dispute resolution review, which shall be remitted to the secretary within sixty days of the informal conference order:
     (1) If the provider or licensee requests a face-to-face conference, the provider or licensee shall pay any costs incurred by the independent review provider that exceed the cost of a telephonic conference, regardless of which party ultimately prevails.
     (2) If the independent review provider's decision supports the entirety of the originally-written contested deficiency or adverse action taken by the secretary, the provider or licensee shall reimburse the secretary for the cost charged by the independent review provider. If the independent review provider's decision supports some of the originally-written contested deficiencies, but not all of them, the independent review provider shall rule as to approximate portions of the expense to be paid by each party.
     (f) Any provider or licensee aggrieved by a decision of the secretary made pursuant to this rule may contest the decision upon making a request for an informal dispute resolution within ten working days of receipt of the notice of the decision.
     (g) Administrative and judicial review may be made in accordance with the provisions of article five, chapter twenty-nine-a of the State Code of West Virginia.
     (h) Any decision issued by the secretary shall be made effective from the date of issuance.
     (i) Immediate relief may be obtained by the provider or licensee upon a showing of good cause made by a verified petition to the circuit court of Kanawha County.
     (j) The pendency of administrative or judicial review does not prevent the secretary or a provider from obtaining injunctive relief as provider or licensee for in this statute.


     NOTE: The purpose of this bill is to
create an informal dispute resolution process available to providers or licensees of the Department of Health and Human Resources.

     §27-1A-12 is new; 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 ***