Senate Bill No. 487
(By Senators Minard and Jenkins)
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[Introduced February 11, 2003; referred to the Committee on
Health and Human Resources; and the to the Committee on the
Judiciary.]
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A BILL to amend and reenact section one, article three-c, chapter
thirty of the code of West Virginia, one thousand nine hundred
thirty-one, as amended, relating to peer review organization
protection; and adding health maintenance organization review
committee to the definition of "review organization"
Be it enacted by the Legislature of West Virginia:
That section one, article three-c, chapter thirty of the code
of West Virginia, one thousand nine hundred thirty-one, as amended,
be amended and reenacted to read as follows:
ARTICLE 3C. HEALTH CARE PEER REVIEW ORGANIZATION PROTECTION.
§30-3C-1. Definitions.
As used in this article:
"Health care professionals" means individuals who are licensed
to practice in any health care field under the laws of this state.
"Peer review" means the procedure for evaluation by health
care professionals of the quality and efficiency of services
ordered or performed by other health care professionals, including
practice analysis, inpatient hospital and extended care facility
utilization review, medical audit, ambulatory care review, and
claims review.
"Professional society" includes medical, psychological,
nursing, dental, optometric, pharmaceutical, chiropractic and
podiatric organizations having as members at least a majority of
the eligible licentiates in the area or health care facility or
agency served by the particular organization.
"Review organization" means any committee or organization
engaging in peer review, including a hospital utilization review
committee, a hospital tissue committee, a medical audit committee,
a health insurance review committee,
a health maintenance
organization review committee, a hospital plan corporation review
committee, a professional health service plan review committee or
organization, a dental review committee, a physicians' advisory
committee, a podiatry advisory committee, a nursing advisory
committee, any committee or organization established pursuant to a
medical assistance program, and any committee established by one or
more state or local professional societies or institutes, to gather
and review information relating to the care and treatment of
patients for the purposes of: (i) Evaluating and improving the quality of health care rendered; (ii) reducing morbidity or
mortality; or (iii) establishing and enforcing guidelines designed
to keep within reasonable bounds the cost of health care. It shall
also mean any hospital board committee or organization reviewing
the professional qualifications or activities of its medical staff
or applicants for admission thereto, and any professional standards
review organizations established or required under state or federal
statutes or regulations.
NOTE: The purpose of this bill is to add peer review
committees established by Health Maintenance Organizations to the
definition of "review organizations," thereby making the
proceedings and records of a Health Maintenance Organization peer
review committee confidential and privileged to the same extent as
are the proceedings and records of peer review committees of other
health insurance review committees.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.
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