H. B. 2795
(By Delegate Flanigan)
[Introduced March 8, 2001; referred to the
Committee on Health and Human Resources then Finance.]
A BILL to amend chapter sixteen of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, by adding
thereto a new article, designated article four-e, relating to
open-heart surgical units; definitions; commissioner of bureau
of health to provide applicants current inventory of existing
open-heart surgical units; determining need for new open-heart
surgical units; quality control of open-heart surgical units;
requiring continuum of care; applicants required to prove
financial feasibility; and requiring applicants to insure
accessibility to patients.
Be it enacted by the Legislature of West Virginia:
That chapter sixteen of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, be amended by adding
thereto a new article, designated article four-e, to read as
follows:
ARTICLE 4E. OPEN-HEART SURGICAL UNITS.
§16-4E-1. Standards for open-heart surgery definitions.
(a) "Open-heart surgery" means a cardiac surgical procedure
during which a heart-lung bypass machine is used to perform the
functions of circulation during surgery. This includes cases which
are classified as DRG's 104, 105, 106, 107 and 109. Coded
procedures not included in those listed may also be used when an
applicant can demonstrate they are open-heart procedures.
(b) "Open-heart surgical unit" means a program providing
open-heart surgery at a single site.
(c) "Commissioner" means the commissioner of the bureau of
public health.
(d) "Applicant" means a person who applies to open an
open-heart surgical unit within the state or to offer additional
open-heart services at an existing unit in the state.
(e) "Study area" means the county or counties, whether in or
out of state, that would be significantly benefited by the opening
of one or more open-heart surgical units.
§16-4E-2. Current inventory.
The commissioner shall provide to each applicant a current
inventory of existing open-heart surgical units in the state and
utilization levels.
§16-4E-3. Need methodology.
(a) For applicants proposing the initiation of new open-heart
surgical services or a new open-heart surgical unit, the study area
for a proposed open-heart surgical unit consists of the county in
which the location of the unit is proposed and any other county
that would significantly benefit from the opening of the unit.
Population projections for out-of-state counties shall be permitted
and based on appropriate sources. In addition, an applicant shall
document the location and utilization of all open-heart surgical
units located in the out-of-state counties of the study area under
consideration as well as the out-migration of residents for cardiac
catheterization services.
(b) Applicants proposing to initiate open-heart surgical
services or existing providers of open-heart surgery proposing
additional open-heart surgery units shall demonstrate:
(1) That at least one thousand diagnostic cardiac
catheterization procedures with ICD-9 codes 37.21, 37.22, 37.23,
and 37.26 have been performed annually or that five hundred
diagnostic cardiac catheterization procedures are projected to be
performed annually using the methodology provided for in the
cardiac catheterization standard, and that using the most recent
three-year average West Virginia open-heart surgery use rate by age
cohort as applied to the population of the applicant's study area,
at least two hundred fifty open-heart surgeries are projected to be
performed at the new unit annually by the third twelve-month period
after initiation of the services:
Provided, That the commissioner shall propose legislative rules to define "use rate by age cohort"
for the purposes of this section. Applicants may also submit
projections based on the national or south use rates by age cohorts
as defined by the National Center for Health Statistics.
(2) That the applicant can reasonably project that at least
two hundred open-heart surgical procedures will be performed
annually by the end of the third year of existence of the proposed
unit or additional services and can further document a contractual
relationship with an existing tertiary care facility to oversee or
manage the applicant's proposed open-heart program. The contract
shall be for a minimum of five years:
Provided, That the
commissioner has the discretion to require compliance with this
subdivision.
(c) The commissioner may give special consideration to a
proposal by two or more acute care facilities proposing a joint
open-heart surgical program at one of the coapplicant's facilities
or at another mutually agreed facility:
Provided, That the service
areas of the applicants are contiguous.
§16-4E-4. Quality.
The applicant shall demonstrate each of the following prior to
final approval of any proposal to open a new unit or expand
existing services:
(a) That a fully staffed and equipped cardiac surgical
intensive-care unit will be properly maintained;
(b) That the applicant is a provider of diagnostic cardiac
catheterization services and has operated at the required levels
for diagnostic cardiac catheterization services for the most recent
twelve-month period;
(c) That the proposed unit shall meet appropriate guidelines
of the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) and the American College of
Cardiology/American Heart Association;
(d) That utilization and quality assurance programs will be
properly maintained; and
(e) That the applicant is accredited by the Joint Commission
on Accreditation of Healthcare Organizations.
§16-4E-5. Continuum of care.
Applicants proposing open-heart surgery services shall
document that they will have in place and make available to all
patients appropriate programs and personnel to provide for all
levels of post open-heart surgical care.
§16-4E-6. Cost.
Applicants must demonstrate the financial feasibility of the
proposed open-heart surgical services by presenting reasonable
projections that show revenues will equal expenses by the end of
the third year of operation. The applicant must also demonstrate
that the capital costs of the project are consistent with accepted
accounting principals and rate setting methodology. The applicant, additionally, must demonstrate that the charges and costs used in
projecting financial feasibility are equitable in comparison to
prevailing rates for similar services in similar hospitals, as
determined by the commissioner.
§16-4E-7. Accessibility.
Applicants proposing open-heart surgical services shall
demonstrate:
(a) The existence of a scheduling priority system based on
patients' medical need without regard to the source of referral or
payment; and
(b) Accessibility to the disabled in compliance with
applicable state and federal laws.
NOTE: The purpose of this bill is to set forth criteria and
standards for authorizing the opening of new open-heart surgical
units or for the expansion of existing open-heart surgical
services. The commissioner of the bureau of health would oversee
proposals to insure that all requirements and standards were met
before authorization would be granted.
This article is new; therefore, strike-throughs and
underscoring have been omitted.
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