West Virginia Code
1 - LEGISLATIVE PURPOSE AND DEFINIT
2 - COMMISSIONER OF HUMAN SERVICES;
3 - APPLICATION FOR AND GRANTING OF
4 - STATE ADVISORY BOARD; MEDICAL S
4A - MEDICAID UNCOMPENSATED CARE FU
4B - PHYSICIAN/MEDICAL PRACTITI
9 - 4 B- 1
9 - 4 B- 2
9 - 4 B- 3
9 - 4 B- 4
9 - 4 B- 5
9 - 4 B- 6
9 - 4 B- 7
9 - 4 B- 8
4C - HEALTH CARE PROVIDER MEDICAID
4D - MEDICAID BUY-IN PROGRAM
4E - LONG-TERM CARE PARTNERSHIP PRO
5 - MISCELLANEOUS PROVISIONS
6 - SOCIAL SERVICES FOR ADULTS
7 - FRAUD AND ABUSE IN THE MEDICAID
8 - CHARITY FOOD BANKS
9 - WV WORKS ACT
CHAPTER 9. HUMAN SERVICES.
ARTICLE 4B. PHYSICIAN/MEDICAL PRACTITIONER PROVIDER MEDICAID ACT.
The following words, when used in this article, have meanings ascribed to them in this section, except in those instances where the context clearly indicates a different meaning:
(a) "Board" means the physician/medical practitioner provider Medicaid enhancement board created to develop, review and recommend the physician/medical practitioner provider fee schedule;
(b) "Physician provider" means an allopathic or osteopathic physician, rendering services within this state and receiving reimbursement, directly as an individual provider or indirectly as an employee or agent of a medical clinic, partnership or other business entity;
(c) "Nurse practitioner" means a registered nurse qualified by virtue of his or her education and credentials and approved by the West Virginia board of examiners for registered professional nurses to practice as an advanced practice nurse independently or in a collaborative relationship with a physician;
(d) "Nurse-midwife" means a qualified professional nurse registered with the West Virginia board of examiners for registered professional nurses who by virtue of additional training is specifically qualified to practice nurse-midwifery according to the statement of standards for the practice of nurse-midwifery as set forth by the American college of nurse-midwives;
(e) "Physician assistant" means an assistant to a physician who is a graduate of an approved program of instruction in primary health care or surgery, has attained a baccalaureate or master's degree, has passed the national certification examination and is qualified to perform direct patient care services under the supervision of a physician;
(f) "Registered nurse first assistant" means one who:
(1) Holds a current active registered nurse licensure;
(2) Is certified in perioperative nursing; and
(3) Has successfully completed and holds a degree or certificate from a recognized program which consists of:
(A) The association of operating room nurses, inc., care curriculum for the registered nurse first assistant; and
(B) One year of post-basic nursing study, which shall include at least forty-five hours of didactic instruction and one hundred twenty hours of clinical internship or its equivalent of two college semesters;
A registered nurse who was certified by the certification board of perioperative nursing before one thousand nine hundred ninety-seven is not required to fulfill the requirements of subdivision (3) of this subsection;
(g) "Perioperative nursing" means a practice of nursing in which the nurse provides preoperative, intraoperative and post-operative nursing care to surgical patients;
(h) "Secretary" means the secretary of the Department of Health and Human Resources; and
(i) "Single state agency" means the single state agency for Medicaid in this state.
§9-4B-2. Physician/medical practitioner provider Medicaid enhancement board; continuation and composition.
There is hereby continued the West Virginia physician/medical practitioner provider Medicaid enhancement board to consist of eleven members. The board shall consist of ten members, appointed by the Governor, and the secretary, or his or her designee, who shall serve as an ex officio, nonvoting member. The members appointed by the Governor shall include five allopathic physicians, one osteopathic physician, one nurse practitioner, one nurse-midwife, and one physician assistant and one lay person. The Governor shall select four allopathic physician board members from a list of eight recommendations submitted to the Governor by the state medical association, one allopathic physician board member from a list of three recommendations submitted to the Governor by the state academy of family physicians, the osteopathic physician board member from three recommendations submitted to the Governor by the state osteopathic society, the nurse practitioner from three recommendations submitted to the Governor by the advanced nursing practice conference group of the West Virginia nurses association, the nurse-midwife from three recommendations submitted to the Governor by the West Virginia chapter of the American college of nurse-midwives, the physician assistant from three recommendations submitted to the Governor by the state physician assistant association and the lay board member, at his or her discretion. The respective associations shall submit their recommendations to the Governor within five days of the effective date of this article. The Governor shall make all appointments within fifteen days from the receipt of all recommendations. After the initial appointment of the board, any appointment to fill a vacancy shall be for the unexpired term only, made in the same manner as the initial appointment, and the terms of all members expire on July 1, 1996. The board shall select a member to act as chairperson. The chairperson shall be the chief administrative officer and shall preside over official transactions of the board.
Each appointed board member shall serve without compensation but shall be reimbursed for the cost of reasonable and necessary expenses actually incurred in the performance of his or her duties.
(a) The board shall:
(1) Develop and recommend a reasonable physician/medical practitioner provider fee schedule that conforms with federal Medicaid laws and remains within the limits of annual funding available to the single state agency for the Medicaid program. In developing the fee schedule, the board may refer to a nationally published regional specific fee schedule selected by the secretary of the Department of Health and Human Resources. The board may consider identified health care priorities in developing its fee schedule to the extent permitted by applicable federal Medicaid laws and may recommend higher reimbursement rates for basic primary and preventive health care services than for other services. If the single state agency approves the fee schedule, it shall implement the physician/medical practitioner provider fee schedule;
(2) Review the fee schedule on a quarterly basis and recommend to the single state agency any adjustments it considers necessary. If the single state agency approves any of the board's recommendations, it shall immediately implement those adjustments and shall report the same to the Joint Committee on Government and Finance on a quarterly basis;
(3) Meet and confer with representatives from each medical specialty area so that equity in reimbursement increases or decreases be achieved to the greatest extent possible;
(4) Assist and enhance communications between participating physician and medical practitioner providers and the Department of Health and Human Resources; and
(5) Review reimbursements in relation to those physician and medical practitioner providers who provide early and periodic screening diagnosis and treatment.
(b) The board may carry out any other powers and duties as prescribed for it by the secretary.
(c) Nothing in this section gives the board the authority to interfere with the discretion and judgment given to the single state agency that administers the state's Medicaid program. If the single state agency disapproves the recommendations or adjustments to the fee schedule, it is expressly authorized to make any modifications to fee schedules as are necessary to ensure that total financial requirements of the agency for the current fiscal year with respect to the state's Medicaid plan are met and shall report the same to the Joint Committee on Government and Finance on a quarterly basis: Provided, That the single state agency shall provide reimbursement for the services of a registered nurse first assistant which reimbursement shall be no less than thirteen and six tenths of one percent of the rate for a surgeon physician. The purpose of the board is to assist and enhance the role of the single state agency in carrying out its mandate by acting as a means of communication between the Medicaid provider community and the agency.
(d) On a quarterly basis, the single state agency and the board shall report to the Joint Committee on Government and Finance the status of the fund, any adjustments to the fee schedule and the fee schedule for each health care provider group identified in section one of this article.
Acts, 1993 1st Ex. Sess., Ch. 7.
Acts, 1993 1st Ex. Sess., Ch. 7.
The physician provider fee schedule, as adopted by the single state agency through recommendations by the board, becomes effective on January 1, 1992.
Acts, 1993 1st Ex. Sess., Ch. 7.