Senate Bill No. 247
(By Senator Grubb)
__________
[Introduced February 1, 1995;
referred to the Committee on Health and Human Resources;
and then to the Committee on 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 one-b, relating to
a universal health care program for West Virginia; providing
legislative findings and purposes; providing definitions for
relevant terms; establishing the West Virginia universal
health care program; providing for universal eligibility for
all residents of the state; listing covered health care
services; prohibiting duplicate coverage; providing for
payment of covered services; providing coverage for certain
nonresidents; providing coverage for residents out-of-state;
allowing freedom of provider choice and requiring certain
reports; creating the West Virginia universal health care
board and providing for the appointment of members thereto
and meetings thereof; setting forth the duties, powers and
authority of the board, including the power to own property,
to enter agreements, to borrow money, to sue and be sued, to develop guidelines for conducting its business affairs, to
solicit and accept grants and proposals and to promulgate
rules; providing for the appointment and powers of the
director of the board; creating the legislative health care
task force; providing for funding; establishing the
universal health care program trust fund; providing for
revenue measures to cover the costs of the program;
requiring the board to seek federal waivers; providing for
the payment of federal funds to the trust fund and
establishing a surcharge on certain individuals; providing
for an effective date of taxes and optional provisions for
certain employers; providing for coverage modifications
under certain circumstances; establishing a legislative
health care task force; requiring a report; repealing the
public employees insurance act; and providing for
severability.
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 one-b, to read
as follows:
ARTICLE 1B. UNIVERSAL HEALTH CARE.
§16-1B-1. Short title.
This article shall be known as the "West Virginia Universal
Health Care Security Act".
§16-1B-2. Legislative findings and purpose.
Based upon careful review of information from consumers,
providers, third-party payers, governmental entities, and other
persons involved or otherwise interested in the state's health
care system, the Legislature finds that a health care crisis
threatens the welfare of the citizens of our state.
The Legislature further finds that access to appropriate,
high quality health care is a basic right of every resident of
the state.
The Legislature further finds that:
(1) Health care costs have increased dramatically in recent
years:
(A) Total health care spending in West Virginia was $1.64
billion in 1980. By 1990, this expenditure level had more than
doubled to $3.85 billion. Just two years later, in 1992, the
amount had increased to $4.5 billion. Studies indicate that,
unless action is taken immediately, this figure will increase to
more than $8 billion by the year 2000;
(B) On a per capita basis, West Virginians spent $843
annually in 1980. By 1990, this number increased to more than
$2,000 per year, with a projected increase to $4,752 by the year
2000; and
(C) In terms of families, health care costs have consumed an
increasingly larger portion of the household budget. In 1980,
West Virginia families spent $1,592 annually. By 1990, this
amount had increased to $3,443, with a projected increase to
$7,706 by the year 2000;
(2) Similarly, access to health care has significantly
declined:
(A) Approximately three hundred thousand West Virginians,
one-third of whom are children, lack any health insurance
coverage. The number of uninsured is increasing at an alarming
rate;
(B) More than four hundred thousand West Virginians are
underinsured, such that their health insurance policies do not
protect them from serious financial hardship in the event of a
medical catastrophe;
(C) Moreover, those West Virginians who do have health
insurance benefits are facing a growing array of co-payments,
premium increases, and rising deductibles; and
(D) Studies demonstrate that uninsured or underinsured
individuals seek medically necessary treatment less frequently
than necessary, thereby increasing overall health care costs in
the long-run;
(3) As a result of increasing costs and declining access,
many West Virginia families are unable to obtain necessary health
care services;
(4) The current structure of the health care system is
inefficient, wasteful, and contributes to inflated costs and
reduced access;
(5) Accordingly, a single administrative health care
financing mechanism could greatly reduce overall administrative
costs and increase the amount of time and resources a health provider has available for patient care;
(6) The resulting savings, coupled with significant cost
control measures, will be sufficient to provide universal
coverage of appropriate health care for all West Virginians;
(7) In spite of the national scope of the health care
crisis, the state can and should take fundamental steps to
address the lack of access to health services and the rising
health services costs in West Virginia.
Therefore, it is the purpose of the Legislature to establish
a program to guarantee universal access to appropriate health
care for all West Virginians, regardless of ability to pay or
current health status.
§16-1B-3. Definitions.
As used in this article:
(1) "Board" means the universal health care board created by
section five of this article.
(2) "Director" means the director of the board appointed
pursuant to section seven of this article.
(3) "Health care provider" means a person, partnership,
corporation, facility or institution licensed or certified or
authorized by law to provide professional health services in this
state to an individual during that individual's health care,
treatment or confinement.
(4) "Health services" means clinically related preventive,
diagnostic, treatment or rehabilitative services, including
alcohol, drug abuse and mental health services.
(5) "Resident" means an individual who:
(A) Lives in West Virginia; and
(B) With the exception of an infant under the age of one
year with parents who are residents, has lived in West Virginia
for a period of at least twelve months: Provided, That the term
does not include an individual who is not otherwise a resident
and lives in West Virginia to attend a school, college, or
university located in the state.
(6) "Universal health program" means the West Virginia
Universal Health Care Program established by this article and
administered by the board.
§16-1B-4. Universal health care program.
There is hereby established a universal health care program
for the state of West Virginia. The program shall include a
single, publicly-financed statewide insurance program providing
comprehensive coverage to all residents of the state for all
health care services that are necessary and appropriate to
maintain health or to diagnose, treat, or rehabilitate following
a disease, injury or disability.
§16-1B-5. Universal eligibility for covered services.
(a) Effective the first day of January, one thousand nine
hundred ninety-six, every person who is a resident of this state
shall be eligible to receive benefits for covered health services
under the West Virginia universal health care program.
(b) No participating provider shall refuse to furnish
services to an eligible person on the basis of race, color, income level, national origin, religion, sex, or other nonmedical
criteria.
§16-1B-6. Covered health services.
(a) Effective the first day of January, one thousand nine
hundred ninety-six, every eligible person is entitled to receive
benefits for any medically necessary and appropriate covered
service furnished within this state by a participating provider.
(b) Covered services shall include, but are not limited to,
the following:
(1) Physician services and services of other licensed health
care providers;
(2) Hospital inpatient and outpatient services;
(3) Nursing facility services;
(4) Home health care services;
(5) Preventive health services, including prenatal and
postnatal care and preventive care for children;
(6) Prescription drugs and biologicals: Provided, That
prescription drugs shall include drugs that are approved by the
federal drug administration and herbal drugs approved as safe and
effective by the board of the West Virginia universal health care
program;
(7) Laboratory tests and imaging services;
(8) Primary and acute dental services, subject to a
limitation to be established by the board for routine procedures
and examinations;
(9) Vision appliances, including lenses, frames and medically necessary contact lenses, for program members:
Provided, That the board shall establish a monetary limitation
for all such appliances;
(10) Home and community-based services, but only for
individuals:
(A) Over eighteen years of age determined: (i) to be unable
to perform, without the assistance of an individual, at least two
of the following five activities of daily living, or who has a
similar level of disability due to cognitive impairment:
bathing, eating, dressing, toileting, and transferring in and out
of a bed or in and out of a chair; or (ii) due to cognitive or
mental impairments, requires supervision because the individual
behaves in a manner that poses health or safety hazards to
himself or herself or others; or
(B) Under eighteen years of age determined to meet such
standard of disability for children as established by the board;
(11) Hospice care;
(12) Mental health services;
(13) Family planning services;
(14) Wellness programs as determined by the board;
(15) Substance abuse treatment, subject to quality assurance
and appropriateness reviews as established by the board; and
(16) Medical supplies, durable medical equipment, and
selected assistive devices: Provided, That all such items shall
be subject to limitations established by the board.
(c) Covered health services do not include any of the following:
(1) Surgery for cosmetic purposes other than for
reconstructive surgery;
(2) Cosmetic dental surgery; and
(3) Medical examinations conducted and medical reports
prepared for either of the following:
(A) Purchasing or renewing life insurance; or
(B) Participating as a plaintiff or defendant in a civil
action for the recovery or settlement of damages.
(d) No later than the first day of July, one thousand nine
hundred and ninety-six, and notwithstanding any provision of
subsections (a) or (b) of this section to the contrary, the board
shall promulgate rules, pursuant to chapter twenty-nine-a of the
code, to provide a three-year phase-in for the coverage of
long-term care services: Provided, That such rules shall
establish regional coordinating agencies throughout the state to
plan, develop and manage a comprehensive system of long-term
support services for older adults and people with disabilities:
Provided, however, That the regional coordinating agencies shall:
(1) establish a single point of entry for long-term support
services;
(2) develop a model case management system that operates
separately from agencies that provide direct services;
(3) establish a system for planning and resource allocation
of long-term support services for individuals within the defined
catchment area;
(4) coordinate and manage the planning and delivery of
long-term care support services with other basic health services;
and
(5) maximize informal systems of long-term support by
developing and expanding programs that assist family caregivers.
§16-1B-7. Duplicate coverage.
On or after the first day of January, one thousand nine
hundred ninety-six, no insurance company, health maintenance
organization or other health care service contractor doing
business in this state shall, with respect to residents of this
state, independently provide health insurance coverage for any
health care services covered by the West Virginia universal
health care program: Provided, That nothing herein shall be
construed to limit an insurance company, health maintenance
organization or other health care service contractor from
offering benefits that do not duplicate any coverage provided by
the program.
§16-1B-8. Payment for covered services.
(a)
Institutional providers.
(1) The West Virginia universal health insurance program
shall pay the expenses of institutional providers, including
providers of inpatient care and ambulatory facilities for
diagnosis, treatment, and surgery services on the basis of global
budgets that are approved by the board.
(2) Each institutional provider shall negotiate an annual
budget with the program to cover its anticipated services for the next year based on past performance and projected changes in
factor prices and service levels.
(3) Every physician or other provider employed by a globally
budgeted institutional provider shall be paid through and in a
manner determined by the institutional provider.
(4) The global budgeting procedure described in subsection
(a) subdivisions (1), (2) and (3) of this section also applies to
institutions that provide program services and that are funded by
any political subdivision or any agency or instrumentality of a
political subdivision. No later than the last day of June, one
thousand nine hundred ninety-five, no political subdivision or
any agency or instrumentality of a political subdivision may fund
these institutions.
(b)
Independent providers.
(1) The program shall reimburse independent providers of
health care services on a fee-for-service basis.
(2) The program shall annually negotiate the fee schedule
with the appropriate professional group.
(3) The fee schedule shall be applied to health care
services rendered by independent providers throughout the state:
Provided, That fee schedules may take into account recognized
differences among geographical areas regarding costs of practice.
(4) To the greatest extent feasible, fee schedule categories
shall include payment for all procedures routinely performed for
a given diagnosis.
(5) The board may specify that certain technical procedures will be reimbursed only when performed in certain institutions or
by designated providers.
(6) A provider may not charge rates that are higher than the
negotiated reimbursement level.
(7) A provider may not charge separately for covered
services under section six of this article.
(8) No later than the first day of January, one thousand
nine hundred and ninety-six, the board of the West Virginia
universal health program shall report to the speaker of the House
of Delegates, the president of the Senate, and the governor, on
alternatives to fee-for-service reimbursement of independent
providers.
(c) A health maintenance organization or any other
multispecialty organization of providers may elect to be
reimbursed on a capitation basis, in lieu of the fee-for-service
basis. If the organization meets enrollment requirements
established by the board, the organization may elect to have
inpatient services provided by globally budgeted institutions
included in its capitation payments. Upon that election, the
institution budgets of these institutions shall be adjusted
accordingly.
§16-1B-9. Coverage for certain nonresidents.
(a) The board of the West Virginia universal health program
shall bill employers located in another state for covered
services rendered in this state to their employees who are
residents of this state.
(b) Any employer located in this state may purchase coverage
under the program for any employee in this state who is a
resident of another state.
(c) Any private or state college, university or other
institution of higher education situated in this state shall
purchase coverage under the program for any student who is not a
resident of this state and who requests coverage: Provided, That
said institution may recover the costs of such coverage from the
non-resident student.
§16-1B-10. Coverage for residents out-of-state.
(a) As used in this section, "public retirement system"
means the police and firemen's disability and pension fund, the
public employees retirement system, the teachers retirement
system or any county or municipal retirement system.
(b) If a program member receiving a pension, benefit or
allowance from a private or public retirement system in this
state establishes residence in another state, the board of the
West Virginia universal health insurance program, in accordance
with subsection (e) of this section, shall pay for services
comparable to the benefits for covered services provided by the
program to persons residing in this state and receiving a
pension, benefit or allowance from a private or public retirement
system in this state. The board may establish a schedule of
partial payments for services based on accumulation of service
credit under a retirement system.
(c) The board, in accordance with subsection (e) of this section, may pay for services rendered to program members in
another state for emergencies, for other urgently needed health
care services, or for reasons relating to the suitability of
medical care, the nature of the condition, personal
circumstances, or historic patterns of health services delivery.
(d) The board, in accordance with subsection (e) of this
section, shall pay for services rendered to program members while
they are temporarily in another state.
(e) The board shall establish and operate an indemnity plan
to provide payments for services under subsections (b), (c) and
(d) of this section. The payments shall be made at the rates
negotiated by the board for benefits for comparable services
provided by the program in this state.
§16-1B-11. Freedom of provider choice, reporting requirements.
(a) A program member may choose any participating provider,
including any physician whether practicing on an independent
basis, in a small group, or in a capitated practice. A program
member who enrolls in a capitated practice may disenroll from
that practice only after a specified interval, which may be not
less than a specified period of time, to be determined by the
board, after enrollment.
(b) Every participating provider shall furnish such
information as may be reasonably required by the board of
governors of the program for utilization review, cost
containment, quality assurance, payment of provider, and
statistical or other studies of the operation of the program.
(c) Every participating provider shall permit the board of
governors to examine its records as may be necessary for
verification of payment.
§16-1B-12. Universal health care board; composition;
appointment; terms; oaths; removal; vacancies; expenses and
compensation; meetings; quorum; records.
(a) The West Virginia universal health insurance program
shall be administered by a board composed of nineteen members,
fifteen of whom shall be appointed by the governor with the
advice and consent of the Senate, and four of whom shall be the
following ex-officio members: The secretary of health and human
services, the secretary of tax and revenue, the director of the
division of insurance and the director of the bureau of public
health. Of the fifteen members appointed by the governor, ten
members shall represent consumers and five shall represent
providers.
(1) Four consumer members shall directly represent consumers
and shall be appointed from a list of nominees submitted by
organizations representing consumers;
(2) Three consumer members shall represent labor and shall
be appointed from a list of six nominees submitted jointly by
organizations representing labor;
(3) Three consumer members shall represent business and
shall be appointed from a list of six nominees submitted jointly
by organizations representing employers;
(4) Two provider members shall represent hospitals and shall be appointed from a list of four nominees submitted jointly by
organizations representing hospitals;
(5) Two provider members shall represent physicians and
shall be selected from a list of four nominees submitted jointly
by organizations representing physicians; and
(6) One provider member shall represent licensed
nonphysician health care professionals who shall be appointed
from a list of two nominees submitted by organizations
representing licensed nonphysician health care professionals.
(b) Each of the fifteen appointees shall be a person who is
knowledgeable and interested in matters pertaining to health care
and health care administration.
(c) (1) Of the initial appointments made by the governor,
which shall be made no later than the thirtieth day of June, one
thousand nine hundred ninety-five, three shall be for a term
ending on the last day of December, one thousand nine hundred
ninety-six; three shall be for a term ending on the last day of
December, one thousand nine hundred ninety-seven; three shall be
for a term ending on the last day of December, one thousand nine
hundred ninety-eight; three shall be for a term ending on the
last day of December, one thousand nine hundred ninety-nine; and
three shall be for a term ending on the last day of December, two
thousand. Thereafter, terms of office shall be for five years,
each term ending on the last day of December.
(2) Each member shall hold office from the date of his
appointment until the end of the term for which the member was appointed. Any member appointed to fill a vacancy occurring
prior to the expiration of the term for which the predecessor was
appointed shall hold office for the remainder of that term.
(3) Each member shall continue in office subsequent to the
expiration date of the term until the successor takes office or
until a period of sixty days has elapsed, whichever occurs first.
(e) The members of the board shall appoint the chair and
vice-chair of the board from among the membership of the board,
which offices shall have two-year terms beginning on the first
day of January.
(f) Meetings shall be held upon the call of the chair and as
may be provided by procedures prescribed by the board.
(g) Ten members of the board constitute a quorum, and the
affirmative vote of ten members shall be necessary for any action
to be taken by the board.
(h) The governor, at any time after notice and opportunity
for hearing, may remove for cause any member appointed by him.
(i) The members of the board shall serve without
compensation, but shall be reimbursed for mileage and their
necessary and actual expenses, including lost wages not to exceed
on hundred and fifty dollars per day, incurred while engaged in
the business of the board.
§16-1B-13. Powers and authority of board generally.
(a) The board of the West Virginia universal health
insurance program shall do all of the following:
(1) Establish budget and policy guidelines for the program;
(2) Establish fee schedules;
(3) Determine aggregate capital expenditures
(4) Propose changes in coverage offered by the program;
(5) Administer and implement the program;
(6) Administer and invest the West Virginia health care
trust fund created under section sixteen of this article;
(7) Develop a plan of operation;
(8) Monitor the operation of the program;
(9) Study the most effective methods of providing
comprehensive personal health services to all persons within this
state;
(10) Report annually to the Legislature and the governor on
its activities and recommend any statutory changes necessary to
improve access to health care for residents of this state;
(11) Disseminate to providers of services and to the public,
information concerning the program and the persons eligible to
receive the benefits of the program;
(12) Study and evaluate the operation of the program,
including, but not limited to, the adequacy and quality of
services furnished under the program, the cost of each type of
service, and the effectiveness of cost containment measures under
the program;
(13) Conduct necessary investigations and inquiries and
compel the submission of information, documents, and records it
considers necessary to carry out its duties under this article;
(14) Conduct other activities necessary to carry out the purposes of this article;
(15) Establish reasonable and effective means of cost
containment;
(16) Establish reasonable and effective means of quality
assurance;
(17) Establish, if the board considers it necessary,
aggregate expenditure limits applicable to categories of health
services;
(18) Establish, if the board considers it necessary, a
system to promote continuity of care;
(19) Establish an indemnity plan to carry out the purposes
set forth in section ten of this article;
(20) Create an ombudsman program for the resolution of
complaints brought by program members regarding any matter
associated with coverage under, or the operation of, the program,
and establish standards for the selection by the executive
director of a health program consumer advocate to carry out the
purposes of the program;
(21) Develop rules, pursuant to chapter twenty-nine-a of
this code, concerning allowable expenses to be included in global
budgets for institutional providers of inpatient care services
and ambulatory care facilities for diagnosis, treatment, and
surgery;
(22) Adopt rules pursuant to chapter twenty-nine-a of this
code to establish standards and procedures for negotiating and
entering into contracts with participating providers; and
(23) Employ and supervise staff.
(b) In addition to the items contained in subsection (a) of
this section, the board may exercise all powers necessary or
appropriate to carry out the purposes of this article, including,
but not limited to, the following:
(1) To acquire, own, hold and dispose of property, whether
such property is real, personal, tangible, intangible or mixed;
(2) To enter into leasing agreements and lease-purchase
agreements, whether as lessee or lessor;
(3) To borrow money, issue forms of indebtedness and
mortgage or otherwise grant security interests in its property,
including as security therefor;
(4) To sue and be sued;
(5) To make bylaws and to develop and implement procedures
governing the internal operation and administration of the
commission, including guidelines for purchasing and conducting
its business affairs involving the expenditure of funds, which
shall not be subject to the provisions of chapter five-a of this
code;
(6) To make contracts of every kind and nature, including,
but not limited to, interstate agreements or compacts, and to
execute all instruments necessary or convenient for carrying on
its business;
(7) To solicit and accept gifts, grants, bequests or
donations of property, funds, security interests, money,
materials, labor, supplies or services from any governmental entity or unit or any person, firm, foundation or corporation and
to do all things necessary, useful, desirable or convenient in
connection with the procuring, acceptance or disposition of gifts
or grants, or the keeping of the terms of any agreement entered
into;
(8) To solicit and accept proposals in furtherance of the
purposes of this article;
(9) To promulgate rules, in accordance with chapter
twenty-nine-a of the code of West Virginia, as amended, designed
to implement and make effective the powers, duties and
responsibilities vested in the board by the provisions of this
article;
(10) To negotiate written agreements and procedures between
and among departments and divisions of state government and
provide or contract with any governmental entities or other
agencies or persons in this state and other states to carry out
the duties and responsibilities of the commission;
(11) To hold public hearings, conduct investigations and
require all officers and employees of governmental entities to
furnish any records or information which the board, or the
director on its behalf, requests for carrying out the purposes of
this article. All hearings of the board shall be announced in a
timely manner and shall be open to the public except as may be
necessary to conduct business of an executive nature. The
commission shall hold any records or information received
confidential as may be required under state or federal law;
(12) To implement the standards and guidelines set forth in
this article; and
(13) To exercise any and all other powers, including the
adoption of an official seal and chartering public and quasi-
public corporations, necessary for the discharge of the
commission's duties and the implementation of the purposes of
this article.
(c) The board may hold public hearings in connection with
any action that it proposes to take under subsections (a) and (b)
of this section. The board shall hold a public hearing prior to
approving any changes in coverage offered by the program. No
public hearing shall be held under this division, unless the
board has provided notice to the general public, affected
providers, and all other interested parties.
§16-1B-14. Executive director of board; appointment; duties.
(a) The board of the West Virginia universal health care
program shall appoint the executive director of the program.
(b) The executive director shall serve as secretary to the
board, shall employ and supervise staff; shall select the health
program consumer advocate; and shall perform other such duties in
the administration of the program as the board may assign.
(c) The director shall be an exempt employee but may be
removed from employment prior to the expiration of his or her
term only for cause.
(d) As secretary of the board, the director shall give bond
in the sum of fifty thousand dollars in the manner provided in article two, chapter six of this code.
(e) The board shall set the salary and terms of employment
for the executive director.
(f) The board may hire such staff as it deems appropriate
and may fix the compensation and terms of employment thereof.
The staff are subject to the provisions of article six, chapter
twenty-nine of this code but are exempt from such provisions for
purposes of compensation. A staff member may be removed from
employment only for cause and otherwise as provided in chapter
twenty-nine of this code.
§16-1B-15. Funding.
(a) On or before the first day of November, one thousand
nine hundred and ninety-five, and each year thereafter, the
commission shall submit to the governor, speaker of the House of
Delegates and president of the Senate an annual budget designed
to cover the costs of the West Virginia universal health care
program: Provided, That each budget shall contain an estimate of
any projected revenue surplus or deficit: Provided, however,
That in the event of a projected revenue deficit, the board shall
recommend a funding mechanism to raise the requisite funds.
(b) The initial budget shall include the following:
(1) An analysis of moneys presently expended by the state
for the delivery of health care services that are available to
cover the costs of the program;
(2) An analysis of moneys available from the federal
government as a result of any waiver of requirements granted by the United State Secretary of Health and Human Services under
health care programs established pursuant to Title XVIII and
Title XIX of the Social Security Act, as amended;
(3) An estimate of any additional state revenues available
to cover the costs of the program and a recommendation concerning
specific legislation needed to dedicate such moneys to the fund
established in section seventeen of this article; and
(4) An estimate of total revenues available as a result of
the taxes levied in section eighteen of this article.
(c) To cover the costs of the board prior to the first day
of July, one thousand nine hundred and ninety-six, the health
care cost review authority and the insurance commission shall
each provide in equal amounts, through interagency transfer to
the board, the sum necessary to cause the state funding for the
board to equal five hundred thousand dollars. The board shall
actively solicit grants and other nonstate funding.
§16-1B-16. Universal health care program trust fund.
(a) There is hereby created in the state treasury the West
Virginia universal health care program trust fund, which shall
consist of all moneys obtained, from whatever source, to cover
the costs of the program.
(b) Moneys in the fund shall not be subject to appropriation
or allotment by the state for any purpose other than covering the
costs of the West Virginia universal health care program.
(c) The board may, as part of the rules authorized pursuant
to section thirteen of this article, establish separate accounts in the trust fund to cover specific areas of the delivery of
covered health cares services.
(d) Revenues held in the trust fund are not subject to
appropriation or allotment by the state or any political
subdivision of the state.
(e) The board shall do all of the following with respect to
the fund:
(1) Administer the fund;
(2) Conduct a quarterly review of the expenditures from and
to the fund;
(3) Ensure that on or after the first day of January, two
thousand, the amount of reserves in the fund at any time shall
equal at least the amount of expenditures from the fund during
the entire three preceding months; and
(4) Invest the fund only in investments that are authorized
by the laws of this state. Any limitations in these laws apply
to the investment of the fund.
§16-1B-17. Revenue measures; definitions; employer, employee
taxes; surcharge on certain individuals; additional taxes on
certain alcoholic beverages and tobacco products; tax on
certain corporations.
(a) As used in this section:
(1) "Employ" means to suffer or to permit to work;
(2) "Employee" means any individual who works for an
employer;
(3) "Employer" means the state of West Virginia, its instrumentalities and its political subdivisions and their
instrumentalities, any individual, partnership, association,
corporation, business trust or any person or group of persons,
acting in the interest of an employer in relation to an employee;
(4) "Price" means the total cost of the property purchased
at retail sale including any other taxes included in that cost;
(5) "Resident" means any person living in this state.
(b) For the purpose of providing revenue for the West
Virginia universal health insurance program, the following taxes
are hereby levied:
(1) On each employer:
(A) A tax equal to four percent of the employer's payroll;
and
(B) A tax on the employer's payroll based on the number of
employees employed by the employer in accordance with the tax
rate schedule set forth in subparagraph (C) of this subdivision.
If the number of employees is equal to or greater than the number
set forth in column one of the tax schedule and less than or
equal to the corresponding number set forth in column two of the
tax schedule, the tax rate shall be the corresponding percentage
of the employer's payroll as set forth in column three of the
rate schedule;
(C) The tax rate schedule for determining the tax on
employers under subsection (b)(1)(B) of this section is as
follows:
TAX RATE SCHEDULE
Number of EmployeesTax Rate
1 - 90.00%
10 - 490.50
50 - 991.00
100 - 2491.75
250 - 4992.50
500 - 9993.20
1000 and greater4.00
(2) On each employee who is a resident a tax equal to one
percent of the employee's gross salary or wage;
(3) On each self-employed individual, a tax equal to five
percent of the individual's self-employment income, subject to
the limit on taxable self-employment income for medicare hospital
insurance under the "Federal Insurance Contributions Act," 26
U.S.C.A. 3101, as amended: Provided, That such tax shall not be
levied on individuals with an adjusted gross income less than one
hundred fifty percent of the federal poverty guidelines.
(4) In addition to the taxes levied by chapter eleven of
this code on any of the following products, a tax on the sale at
retail of cigarettes, cigars, snuff and other tobacco products
equal to ten percent of the price;
(5) In addition to the taxes levied by chapter eleven of
this code on any of the following products, a tax on the sale at
retail of wine, sparkling and carbonated wine and champagne
vermouth, beer, malt liquor and mixed beverages, equal to ten per
cent of the price;
(6) In addition to the taxes levied by chapter eleven of
this code, a tax on the sale at retail of spirituous liquor of
ten percent of the price; and
(7) A surcharge on individuals as detailed in subsection (b)
of section nineteen of this article.
(c) To the extent that the board of the West Virginia
universal health insurance program determines that the
aforementioned revenues are insufficient to cover the projected
costs of the program, it shall recommend measures designed to
raise additional revenues to the speaker of the House of
Delegates, president of the Senate, and governor, no later than
the first day of December of each year following enactment of
this article: Provided, That such revenues shall be derived from
severance taxes on natural resources, property taxes on excess
acreage, and a progressive increase in personal income taxes.
(d) The board of the West Virginia universal health
insurance program shall adopt rules, pursuant to chapter
twenty-nine-a of this code, regarding the levy and collection of
the taxes described in subsection (b) of this section, and may
enter into contract with the department of tax and revenue for
the collection of the taxes levied by this section.
§16-1A-18. Waivers.
On or before the first day of August, one thousand nine
hundred and ninety-five, the board, in conjunction with the
secretary of the department of health and human resources, shall
do the following:
(1) Apply for all waivers of requirements under health
programs established under Title XVIII and Title XIX of the
Social Security Act, as amended, that are necessary to enable
this state to deposit all federal payments under those programs
in the state treasury to the credit of the West Virginia
universal health care program trust fund established established
pursuant to section sixteen of this article; and
(2) Identify any other federal programs that provide federal
funds for payment of health care services to individuals. The
board and/or department shall comply with any requirements under
those programs and apply for any waivers of those requirements
that are necessary to enable this state to deposit such federal
funds to the credit of the West Virginia health care program
trust fund.
§16-1B-19. Payment of federal funds into trust fund; surcharge
on certain individuals.
(a) No later than the last day of December, one thousand
nine hundred ninety-five, the board of the West Virginia
universal health insurance program and the department of health
and human resources shall explore and cooperate with, enter into
any necessary contract or other arrangement with, and otherwise
pursue any other reasonable course of action with the secretary
of health and human services to establish procedures, standards
and conditions under which the department shall pay to the West
Virginia health care trust fund amounts equivalent to those
amounts that, on the effective date of this section, are paid on behalf of residents of this state for health benefits under
Titles XVIII and XIX of the "Social Security Act," 49 Stat. 620
(1935), 42 U.S.C.A. 301, as amended;
(b) Effective the first day of January, one thousand nine
hundred and ninety-six, the state of West Virginia shall impose
and collect for payment into the fund a long-term care surcharge,
plus twenty-five dollars per month, on residents of this state
subject to the cost-sharing provisions of Title XVIII of the
"Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as
amended, in amounts necessary to replace payments made by
residents of this state under said cost-sharing provisions:
Provided, That such surcharge shall not be levied on individuals
with an annual adjusted gross income less than one hundred twenty
percent of federal poverty guidelines.
§16-1B-20. Effective date of taxes and optional provisions for
certain employers.
(a) The taxes that are authorized under section seventeen of
this article shall be levied commencing the first day of January,
one thousand nine hundred ninety-six: Provided, That the taxes
authorized under section seventeen, subsection (b), subdivisions
four, five and six of this article shall be levied commencing the
first day of July, one thousand nine hundred ninety-five.
(b) Any employer whose employee health benefit costs, on the
first day of January, one thousand nine hundred ninety-six,
exceed four percent of its payroll may continue its existing
coverage until the expiration of the plan or contract that provides for this coverage. Upon the expiration of the plan or
contract, the employer shall convert to coverage under the West
Virginia universal health insurance program.
(c) Any employer whose employee health benefit costs, on the
first day of January, one thousand nine hundred ninety-six, are
less than four percent of its payroll shall pay to the West
Virginia health care trust fund the amount by which its current
payments are less than four percent.
(d) Any employer that, on the first of January, one thousand
nine hundred ninety-six, does not make any payments for health
care for its employees shall pay a two percent payroll tax in the
year one thousand nine hundred ninety-six, a three percent
payroll tax in the year one thousand nine hundred ninety-seven,
and a four percent payroll tax in every subsequent year, pursuant
to section seventeen of this article.
§16-1B-21. Coverage modifications under certain circumstances.
(a) Any employer that, on the date benefits are initially
provided by the West Virginia universal health insurance program,
is subject to a collective bargaining agreement that provides
benefits greater than those benefits provided by the program
shall, unless the agreement otherwise provides, maintain the
negotiated level of benefits until the expiration of the
agreement.
(b) Any employer that, on the date benefits are initially
provided by the program, is subject to a collective bargaining
agreement that provides benefits that are less than those benefits provided by the program shall do either of the
following:
(1) Become a member of the program; or
(2) Provide additional benefits so that, until the
expiration of the agreement, benefits provided by the employer
are the same as the benefits provided under the program.
§16-1B-22. Legislative health care task force.
There is hereby created a permanent legislative task force
on health care to study, review and examine the work of the board
and to monitor the development and implementation of the
universal health care program. The task force may request the
board to study and make recommendations regarding any particular
question related to health care, and the board shall do so. The
task force shall review and make recommendations to the
Legislature regarding any plan or policy proposed by the board.
The members of the task force shall be those appointed by the
speaker of the House of Delegates and the president of the
Senate.
§16-1B-23. Reporting requirements.
(a) The secretary of health and human resources shall
prepare, in cooperation with the secretary of tax and revenue and
the secretary of administration, a report identifying and
evaluating the probable effects on the quality and costs of
health care in this state that would result from requiring that
all money that local governmental agencies raise through locally
imposed taxes and currently spent for local health care be deposited instead in the state treasury to the credit of the West
Virginia health care trust fund created by section sixteen,
article one-b of this chapter. The department of health and
human resources shall serve as lead agency and provide staff
services and office facilities as needed for preparation of the
report. On or before the last day of December, one thousand nine
hundred ninety-five, the secretary of health and human resources
shall submit the report to the speaker of the House of Delegates,
the president of the Senate and the governor.
(b) On or before the last day of December, one thousand nine
hundred ninety-five, and each year thereafter, the board shall
prepare an annual report detailing its activities for the
preceding year and outlining recommendations for legislative
action needed to improve the operation of the program. The
report shall be submitted to the speaker of the House of
Delegates, the president of the Senate and the governor.
§16-1B-24. Public employees insurance act repealed.
Effective the first day of January, one thousand nine
hundred ninety-six, and notwithstanding any provisions of this
code to the contrary, the provisions of chapter five, article
sixteen of this code are hereby repealed.
§16-1B-25. Severability.
The provisions of this article are declared to be severable.
If any provision of this article shall be held invalid, the
remaining provisions shall remain in effect.
NOTE: The purpose of this bill is to establish a universal
health care insurance program providing comprehensive health care
benefits for all residents of the state.
This article is new; therefore, strike-throughs and
underscoring have been omitted.