ENGROSSED
COMMITTEE SUBSTITUTE
FOR
COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 137
(By Senators Tomblin, Mr. President, and Boley,
By Request of the Executive)
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[Originating in the Committee on Finance;
reported March 1, 1995.]
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A BILL to amend and reenact section three, article two-d, chapter
sixteen of the code of West Virginia, one thousand nine
hundred thirty-one, as amended; to further amend said
article by adding thereto a new section, designated section
five-a; and to further amend said chapter by adding thereto
a new article, designated article thirty-five, all relating
to certificate of need requirements for new hospice
services; authorizing the health care cost review authority
to amend the certificate of need standards and the state
health plan; authorizing the health care cost review
authority to declare a limited moratorium for purposes of
amending or modifying obsolete or nonexistent standards;
creating the office of health information and analysis as a
distinct unit of the state agency; setting forth the purpose of the office; creating an advisory council and designating
membership; authorizing the access of health data from state
agencies; creating a special revenue fund; requiring the
transfer of funds from other state agencies; authorizing
purchases of health information and management services; and
providing for a termination date.
Be it enacted by the Legislature of West Virginia:
That section three, article two-d, chapter sixteen of the
code of West Virginia, one thousand nine hundred thirty-one, as
amended, be amended and reenacted; that said article be further
amended by adding thereto a new section, designated section five-
a; and that said chapter be further amended by adding thereto a
new article, designated article thirty-five, all to read as
follows:
ARTICLE 2D. CERTIFICATE OF NEED.
§16-2D-3. Certificate of need.
Except as provided in section four of this article, any new
institutional health service may not be acquired, offered or
developed within this state except upon application for and
receipt of a certificate of need as provided by this article.
Whenever a new institutional health service for which a
certificate of need is required by this article is proposed for
a health care facility for which, pursuant to section four of
this article, no certificate of need is or was required, a
certificate of need shall be issued before the new institutional
health service is offered or developed. No person may knowingly charge or bill for any health services associated with any new
institutional health service that is knowingly acquired, offered
or developed in violation of this article and any bill made in
violation of this section is legally unenforceable. For purposes
of this article, a proposed "new institutional health service"
includes:
(a) The construction, development, acquisition or other
establishment of a new health care facility or health maintenance
organization;
(b) The partial or total closure of a health care facility
or health maintenance organization with which a capital
expenditure is associated;
(c) Any obligation for a capital expenditure incurred by or
on behalf of a health care facility, except as exempted in
section four of this article, or health maintenance organization
in excess of the expenditure minimum or any obligation for a
capital expenditure incurred by any person to acquire a health
care facility. An obligation for a capital expenditure is
considered to be incurred by or on behalf of a health care
facility:
(1) When a contract, enforceable under state law, is entered
into by or on behalf of the health care facility for the
construction, acquisition, lease or financing of a capital asset;
(2) When the governing board of the health care facility
takes formal action to commit its own funds for a construction
project undertaken by the health care facility as its own contractor; or
(3) In the case of donated property, on the date on which
the gift is completed under state law;
(d) A substantial change to the bed capacity of a health
care facility with which a capital expenditure is associated;
(e) (1) The addition of health services which are offered by
or on behalf of a health care facility or health maintenance
organization and which were not offered on a regular basis by or
on behalf of the health care facility or health maintenance
organization within the twelve-month period prior to the time the
services would be offered; and
(2) The addition of ventilator services for any nursing
facility bed by any health care facility or health maintenance
organization;
(f) The deletion of one or more health services, previously
offered on a regular basis by or on behalf of a health care
facility or health maintenance organization which is associated
with a capital expenditure;
(g) A substantial change to the bed capacity or health
services offered by or on behalf of a health care facility,
whether or not the change is associated with a proposed capital
expenditure, if the change is associated with a previous capital
expenditure for which a certificate of need was issued and if the
change will occur within two years after the date the activity
which was associated with the previously approved capital
expenditure was undertaken;
(h) The acquisition of major medical equipment;
(i) A substantial change in an approved new institutional
health service for which a certificate of need is in effect. For
purposes of this subdivision, "substantial change" shall be
defined by the state agency in regulations adopted pursuant to
section eight of this article;
(j) An expansion of the service area of any entity which
provides hospice or home health services, regardless of the time
period in which the expansion is proposed or made.
§ 16-2D-5a. State health plan; moratorium.
(a) The state agency shall be responsible for coordinating
and developing the health planning research efforts of the state
and for amending and modifying the state health plan which
includes the certificate of need standards.
(b) When the state agency proposes amendments or
modifications to the state health plan, it shall file with the
secretary of state, for publication in the state register, a
notice of proposed action, including the text of all proposed
amendments and modifications and a date, time and place for
receipt of general public comment. To comply with the public
comment requirement of this section, the state agency may hold a
public hearing or schedule a public comment period for the
receipt of written statements or documents.
All proposed amendments and modifications to the state
health plan, with a record of the public hearing or written
statements and documents received pursuant to a public comment period, shall be presented to the governor. Within thirty days
of receiving said proposed amendments or modifications, the
governor shall either approve or disapprove all or part of said
amendments and modifications and, for any portion of amendments
or modifications not approved, shall specify the reason or
reasons for nonapproval. Any portions of the amendments or
modifications not approved by the governor may be revised and
resubmitted.
(c) The state agency is hereby empowered to order a
moratorium upon the processing of an application or applications
for the development of a new institutional health service filed
pursuant to this article, when criteria and guidelines for
evaluating the need for such new institutional health service
have not yet been adopted or are obsolete. Such moratorium shall
be declared by a written order which shall detail the
circumstances requiring the moratorium. Upon the adoption of
criteria for evaluating the need for the new institutional health
service affected by the moratorium, or one hundred eighty days
from the declaration of a moratorium, whichever is less, the
moratorium shall be declared to be over and affected applications
shall be processed pursuant to this article.
ARTICLE 35. OFFICE OF HEALTH INFORMATION AND ANALYSIS.
§16-35-1. Findings.
The Legislature finds that:
(1) Successful efforts to control the state's rapidly
escalating health care costs depend on the state's policymakers having access to accurate and timely information about the full
range of health care services and programs offered by the state;
(2) Gathering and analyzing health information in a manner
that is useful to policymakers is a complicated and potentially
costly task requiring specialized knowledge of health care policy
and computerized information systems;
(3) Various state health programs independently collect
state health information from at least eighty-five different
health-related data bases with nominal interagency coordination;
(4) The large number of persons insured by state health
programs requires that state government participate effectively
in the development of private and public sector electronic and
community health information systems;
(5) The public and the state's policymakers find it
extremely difficult to obtain comprehensive health information
and analysis because of the numerous sources of such information
and other barriers;
(6) No place exists in state government that has the
expertise, technical resources and authority to coordinate the
collection and dissemination of all health care information
needed by policymakers, the private sector and the public; and
(7) State health programs, policymakers, the private sector
and the public can benefit by pooling expertise, resources and
authority from various state health programs into a single office
to meet the state's health information and analysis needs.
§16-35-2. Office of health information and analysis.
There is hereby created the office of health information and
analysis, to be a distinct unit in the health care cost review
authority. The purpose of the office is to gather and analyze
health care related data. The office shall have a director
appointed by the health care cost review authority and adequate
staff to be employed pursuant to section seven, article twenty-
nine-b of this chapter. The office shall:
(a) Coordinate the collection and analysis of health care
information by state health programs;
(b) Make accurate, timely and useful health care information
available to policymakers and to the public for health planning
and policy purposes;
(c) Work specifically with the secretary of health and human
resources to improve the medicaid program's ability to provide
policymakers with timely, accurate and useful information;
(d) Work specifically with the commissioner of employment
programs to improve the workers' compensation program's ability
to provide policymakers with timely, accurate and useful
information;
(e) 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 within the state and that will coordinate the
development and use of electronic health information systems
within state government;
(f) Establish minimum requirements and complementary reports for the information systems of all state health programs,
including simplifying and standardizing forms, establishing
information standards and reports for capitated managed care
programs to be managed by the insurance commission and defining
and recommending a comprehensive system to collect ambulatory
health care data to be managed by the health care cost review
authority; and
(g) Coordinate the collection of information needed to allow
the health care cost review authority to develop recommended
modifications to certificate of need standards as required in
article two-d of this chapter.
§16-35-3. Advisory council.
To assist the office of health information and analysis in
the performance of its duties, an advisory council is hereby
created consisting of one representative each from the public
employees insurance agency, the health care cost review authority
commissioners, the workers' compensation commission, the
insurance commission, the state medicaid program, the bureau of
public health, the office of community and rural health services,
the office of the vice-chancellor for health sciences and such
other state health programs as necessary, plus six citizen
members who shall be chosen by the governor and shall consist of
the following: Two persons representing private sector health
care providers, two persons representing private sector
purchasers and two persons representing consumers. The terms of
each member shall be for three years, except that of those initially appointed, two shall be appointed for one year, two
shall be appointed for two years and two shall be appointed for
three years. The governor shall make the initial appointments to
the board no later than the first day of September, one thousand
nine hundred ninety-five. Citizen members may be reimbursed by
the office for reasonable travel expenses incurred in the
exercise of his or her official duties.
§16-35-4. Access to state health program data bases.
The office of health information and analysis is authorized
to gain access to any health-related database in state government
for the purposes of fulfilling its duties: Provided, That, for
any database to which the office gains access, the office of
health information and analysis shall be required to abide by all
the confidentiality provisions applicable to the state health
program managing that database.
§16-35-5. Office of health information and analysis fund.
In order to fund the office of health information and
analysis, there is hereby created in the state treasury a special
revolving fund to be known and designated as the "office of
health information and analysis fund". This fund shall consist
of appropriations made by the Legislature, funds received from
other state agencies and funds received from grants, contracts or
donations from other sources for services or other activities
undertaken by the office of health information and analysis in
order to comply with the purposes of this section. The fund
shall initially receive two hundred thousand dollars from the health care cost review authority account, fund 5375-513, and one
hundred thousand dollars from the insurance commission account,
fund 7152-099. Each state agency managing a health-related
database is hereby authorized and directed to transmit to the
office of health information and analysis for deposit in said
special fund the charges made by the office of health information
and analysis for services rendered to that agency relating to the
coordination and analysis of health care information. For fiscal
years one thousand nine hundred ninety-six and thereafter, such
charges shall be fixed in a schedule or schedules approved by the
secretary of the department of health and human resources and may
be paid in advance of such services being rendered.
§16-35-6.
Purchasing of health information and services.
The office of health information and analysis is hereby
authorized to purchase health information and management services
on behalf of any state health program, or combination of state
health programs, upon approval of the secretary of each
department in which such state health program or programs are
located. Said purchases of health information and management
services shall not be subject to the purchasing provisions of
article three, chapter five-a of this code: Provided, That before
entering into any such contract for a sum greater than ten
thousand dollars, the office of health information and analysis
shall invite bids from all vendors qualified to provide the
requested services, deal directly with such vendors in presenting
specifications and receiving quotations for bid purposes, and evaluate bids on a competitive basis, taking into account the
experience of the offering vendor, the quality of the vendor's
services, and the costs of the vendor's proposal.
§16-35-7. Termination.
The office of health information and planning shall
terminate on the first day of July, one thousand nine hundred
ninety-eight, unless extended by legislation prior to that date.