WEST virginia legislature

2022 regular session

ENROLLED

Committee Substitute

for

Senate Bill 553

By Senators Sypolt, Azinger, Clements, Grady, Hamilton, Karnes, Martin, Maynard, Phillips, Roberts, Smith, Stover, Swope, Takubo, Tarr, Trump, Weld, Woodrum, Rucker, and Nelson

[Passed March 08, 2022; in effect from passage]

AN ACT to amend and reenact §16-29B-8, §16-29B-24, and §16-29B-25 of the Code of West Virginia, 1931, as amended, all relating to the powers of the West Virginia Health Care Authority; removing authority to adopt, amend, and repeal policy guidelines; making technical changes; requiring legislative rulemaking regarding the uniform bill; permitting fees for custom data request; and requiring the Secretary of the Department of Health and Human Resources to give notice and file legislative rules when assuming the West Virginia Health Care Authority’s data repository powers and duties.

Be it enacted by the Legislature of West Virginia:

ARTICLE 29B. HEALTH CARE AUTHORITY.

§16-29B-8. Powers generally; budget expenses of the authority.

The authority may:

(1) In cooperation with the secretary, propose legislative rules in accordance with §29A-3-1 et seq. of this code;

(2) Hold public hearings, conduct investigations, and require the filing of information relating to matters affecting the costs of health care services subject to the provisions of this article, and may subpoena witnesses, papers, records, documents, and all other data in connection therewith. The board may administer oaths or affirmations in any hearing or investigation; and

(3) Exercise, subject to limitations or restrictions herein imposed, all other powers which are reasonably necessary or essential to affect the express objectives and purposes of this article.

§16-29B-24.  Reports required to be filed; and legislative rulemaking regarding uniform bill database.

(a) A covered facility, within 120 days after the end of its fiscal year, unless granted an extension by the authority, shall file with the authority its annual financial report prepared by an accountant or auditor.

(b) A covered facility, if applicable by legislative rule, shall submit, upon request of the authority, but at least annually:

(1) A statement of charges for all services rendered, except a behavioral health facility shall submit its gross rates for its top 30 services by utilization;

(2) The Health Care Authority financial report, through the uniform reporting system;

(3) The current Uniform Bill form in effect for inpatients. This data is not subject to the provisions of §16-29B-25(f) of this code: Provided, That the authority, in cooperation with the secretary, shall propose rules for legislative approval in accordance with the provisions of §29A-3-1 et seq. of this code within the applicable time limit to be considered by the Legislature during the regular session of the Legislature, 2023. The legislative rule shall include the following:

(A) Procedures for the collection, retention, use, and disclosure of data from the uniform bill database, including provisions and safeguards to protect the privacy, integrity, confidentiality, and availability of any data;

(B) Procedures for the collection of required data elements, required data format, code tables, edit specifications, thresholds required for a submission to be deemed complete, methods for submitting data, and submission schedules;

(C) Fees not to exceed $50 per custom data request payable by users of the data, if any; and

(D) Repeal of all other existing policies, manuals, and guidelines regarding the submission of uniform bill data promulgated by the authority, as of the effective date of the legislative rule or July 1, 2024, whichever comes first.

(c) The authority may request from a covered facility, except hospitals, the information from §16-29B-24(a) and §16-29B-24(b) of this code from its related organization.

(d) A home health agency shall annually submit a utilization survey.

(e) A covered facility failing to submit a report to the authority shall be notified by the authority and, if the failure continues for 10 days after receipt of the notice, the delinquent facility or organization is subject to a penalty of $1,000 for each day thereafter the failure continues.

§16-29B-25.  Data repository.

(a) The authority shall:

(1) Coordinate and oversee the health data collection of state agencies;

(2) Lead state agencies’ efforts to make the best use of emerging technology to affect the expedient and appropriate exchange of health care information and data, including patient records and reports; and

(3) Coordinate database development, analysis, and report to facilitate cost management, review utilization review and quality assurance efforts by state payor and regulatory agencies, insurers, consumers, providers, and other interested parties.

(b) A state agency collecting health data shall work through the authority to develop an integrated system for the efficient collection, responsible use, and dissemination of data and to facilitate and support the development of statewide health information systems that will allow for the electronic transmittal of all health information and claims processing activities of a state agency within the state, and to coordinate the development and use of electronic health information systems within state government.

(c) The authority shall establish minimum requirements and issue reports relating to information systems of state health programs, including simplifying and standardizing forms and establishing information standards and reports for capitated managed care programs.

(d) The authority shall develop a comprehensive system to collect ambulatory health care data.

(e) The authority may access any health-related database maintained or operated by a state agency for the purposes of fulfilling its duties. The use and dissemination of information from that database shall be subject to the confidentiality provisions applicable to that database.

(f) A report, statement, schedule, or other filing may not contain any medical or individual information personally identifiable to a patient or a consumer of health services, whether directly or indirectly.

(g) A report, statement, schedule, or other filing filed with the authority is open to public inspection and examination during regular hours. A copy shall be made available to the public upon request upon payment of a fee.

(h) The authority may require the production of any records necessary to verify the accuracy of any information set forth in any statement, schedule, or report filed under the provisions of this article.

(i) The authority may provide requested aggregate data to an entity.  The authority may charge a fee to an entity to obtain the data collected by the authority.  The authority may not charge a fee to a covered entity to obtain the data collected by the authority.

(j) The authority shall provide to the Legislative Oversight Commission on Health and Human Resources Accountability before July 1, 2018, and every other year thereafter, a strategic data collection and analysis plan:

(1) What entities are submitting data;

(2) What data is being collected;

(3) The types of analysis performed on the submitted data;

(4) A way to reduce duplicative data submissions; and

(5) The current and projected expenses to operate the data collection and analysis program.

(k) The Secretary of the Department of Health and Human Resources may assume the powers and duties provided to the authority in this section, if the secretary determines it is more efficient and cost effective to have direct control over the data repository program. To the extent that the secretary assumes the powers and duties in this section, the secretary shall inform the Legislative Oversight Commission on Health and Human Resources Accountability by July 1, 2023, and on July 1 of each year thereafter, regarding each program for which he or she is exercising such authority and shall propose rules for legislative approval in accordance with the provisions of §29A-3-1 et seq. of this code within the time limit to be considered by the Legislature during its next regular session. In the event the secretary has already assumed the powers and duties provided to the authority in this section, the secretary shall propose rules for legislative approval in accordance with the provisions of §29A-3-1 et seq. of this code within the time limit to be considered by the Legislature during the regular session of the Legislature, 2023.