H. B. 2536

(By Delegate Walters)
[Introduced February 17, 1995; referred to the
Committee on Health and Human Resources then Finance.]

A BILL to amend and reenact chapter sixteen of the code of West Virginia, one thousand nine hundred thirty-one, as amended, by adding thereto a new article designated article two-i, relating to the rural hospital deregulation act; definitions; intent; duties of the division of health and human resources; rule-making authority; advisory board; increase of midlevel providers; prohibiting requirement of certificate of need; and, authorizing lease of state owned buildings not on tax rolls.

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 and reenacted by adding thereto a new article designated article two-i, to read as follows:

§16-2I-1. Short title.

This article shall be known and may be cited as the "Rural Hospital Deregulation Act."
§16-2I-2. Legislative findings and declaration of intent.
The Legislature hereby finds and declares as follows:
(a) That excessive regulation has had an adverse impact on the stability of rural hospitals;
(b) That a need exists to strengthen and, in some cases, salvage, rural hospitals to ensure that adequate access to services is provided to residents of rural areas as well as to tourists and other travelers; and,
(c) That in order to adequately address the problems encountered by rural hospitals, a comprehensive approach must be undertaken.
The Legislature, therefore, declares its intent to improve the stability of rural hospitals by exempting them from unnecessary procedural, licensure, and bureaucratic restrictions.
§16-2I-3. Definitions.
For the purposes of this article, the following terms are defined as follows:
(a) "Department" means the department of health and human resources;
(b) "Secretary" means the secretary of the department of health and human resources;
(c) "Rural hospital" means an acute care hospital existing outside the incorporated limits of any municipality with more than five thousand persons, which is no less than thirty five miles by road or highway from the nearest existing acute care hospital located in an incorporated municipality of no less than five-thousand persons;
(d) "Medical shortage area" means a county, or other substantial geographical area in which the nearest acute care hospital is no less than thirty-five miles by road or highway from the nearest existing acute care hospital;
(e) "Midlevel providers" means providers of medical services who are not doctors of medicine or osteopathy who are fully licensed and approved to practice, but who are registered nurses, nurse-midwives, graduate medical students and medical residents.
§16-2I-4. Curative measures to be addressed by division of health and human resources.
(a) In order to decrease the regulatory burden that is increasingly threatening the stability of rural hospitals in this state, the secretry shall institute a program designed to accomplish the following:
(1) Provide regulatory relief to rural hospitals, when appropriate, through flexibility in staffing, space and physical plant requirements;
(2) Modify inpatient limitations for medicaid so as not to impose unreasonable financial and administrative burdens that single out rural hospitals for application;
(3) Set reimbursement rates for outpatient services at a level which provides incentives for rural hospitals to focus on the provision of outpatient services and which reduces the financial losses incurred by rural hospitals in providing those services;
(4) Seek necessary waivers from the federal health care financing administration; and
(5) Implement regulatory changes to reduce the requirements for the licensing of rural hospitals.
(b) The secretary is authorized to make rules to effectuate his or her duties as set forth herein and to otherwise effectuate the purposes of this article.
(c) The governor with the advice and consent of the Senate President and the Speaker of the House of Delegates shall appoint an advisory board composed of three persons, two of which shall be administrators of rural hospitals and one who shall be a physician who practices in a rural hospital. The advisory board shall assist the secretary in determining appropriate levels for inpatient limitations and reimbursement rates. The advisory board shall additionally assist the secretary in determining appropriate waivers to seek from the federal health care financing administration and in determining needed regulatory changes. The advisory board shall commence its activities on the first day of July one thousand nine hundred ninety-five and shall continue to serve in an advisory capacity until the conclusion of two years, at which time the board shall cease to exist.
§16-2I-5. Midlevel providers' services to be utilized where necessary.
(a) No licensing board may prohibit registered nurses from performing services at any rural hospital as a physician substitute in a medical shortage area.
(b) Nurse-midwives shall be permitted to deliver babies in a medical shortage area. A rural hospital without a physician performing obstetrics may not restrict a nurse-midwife from admitting patients. Home deliveries may not be restricted in a home delivery area.
(c) Graduate medical osteopathic students and medical and osteopathic residents may provide health care at rural hospitals in their respective specialties with the approval of their respective supervising physicians.
§16-2I-6. Certificate of need not required; leasing of state owned buildings.
(a) No certificate of need may be required from any rural hospital in a medical shortage area for any reason.
(b) Any state-owned building, not listed on the land books for tax purposes, suitable to the needs of any rural hospital or other duly licensed and authorized health care provider may be leased at fair market value from the appropriate state office or agency for use in providing medical, osteopathic and other health care services by such rural hospital or other health care provider.

NOTE: The purpose of this bill is to create the rural hospital deregulation act. The bill seeks to ease regulatory burdens on small rural hospitals while allowing them to utilize midlevel health care providers' services, such as nurse-midwives, nurses, medical and osteopathic graduate students and residents. The bill also places duties on the Secretary of the Department of Health and Human Services to ease burdensome rules, modify inpatient limitations for medicaid, and set reimbursement for outpatient services. The bill also creates an Advisory Board to assist the Secretary of Health and Human Services in carrying out the purposes of the article while also granting authorization for rule making in order to carry out the purposes. Finally, the bill authorizes rural hospitals to lease state buildings not listed on the land books for use.

This article is new; therefore, strike-throughs and underscoring have been omitted.