ENGROSSED
COMMITTEE SUBSTITUTE
FOR
SENATE BILL No. 161
(By Senators Tomblin, Mr. President, and Boley,
By Request of the Executive)
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[Originating in the Committee on Education;
reported February 3, 1995.]
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A BILL to amend and reenact sections two, three, four, six and
nine, article sixteen, chapter eighteen-b of the code of
West Virginia, one thousand nine hundred thirty-one, as
amended, relating to creating the West Virginia rural health
advisory panel; legislative findings; definitions;
continuing the rural health initiative; reports and audit
required; and termination date.
Be it enacted by the Legislature of West Virginia:
That sections two, three, four, six and nine, article
sixteen, chapter eighteen-b of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, be amended and
reenacted to read as follows:
ARTICLE 16. HEALTH CARE EDUCATION.
§18B-16-2. Legislative findings and declarations.
(a) The Legislature hereby finds and declares that the
health of the citizens of West Virginia is of paramount
importance; that the education of health care professionals must be reshaped; that the delivery of health care services must be
improved; that refocusing health sciences education will aid in
the recruitment of health care professionals and their retention
in the state; that the educational process should incorporate
clinical experience in rural areas and provide improved
availability of health care services throughout the state,
especially in rural areas; and that the state investment in such
education and services must be contained within reasonable
limits.
(b) The Legislature further hereby finds and declares that
the vice chancellor for health sciences shall provide an integral
link among the advisory panel created in section six of this
article, the health sciences programs at the state institutions
of higher education, the governing boards of the state's
institutions of higher education and the joint commission for
vocational-technical-occupational education to assure cooperation
and the coordination of efforts to effectuate the goals set forth
in section four of this article.
(c) It is the further finding of the Legislature that the
appropriations pursuant to section eight of this article are made
with the understanding that the educational and clinical programs
existing at the schools of medicine on the effective date of this
section, as well as the goals of this article, will be met
without requests for increases in the annual appropriations
through the fiscal year beginning on the first day of July, one
thousand nine hundred ninety-five, with the exception of
requested increases in appropriations for the purpose of meeting any increases in the salaries of personnel as may be given to
other employees at state institutions of higher education under
the board of trustees.
(d) The Legislature further finds that there is a serious
need throughout the state for a greater number of primary care
physicians and allied health care professionals and a serious
need for improved accessibility to adequate health care
throughout the state, especially in rural areas; that the state's
medical schools are finding it difficult to satisfy the ever
increasing demand for qualified persons to deliver these health
care services; and that the state's institutions of higher
education and rural health care facilities existing throughout
the state are a major educational resource for training students
in these health care services, as well as a major resource for
providing health care to underserved citizens of this state.
(e) The Legislature further finds that in order to provide
adequate health care in rural communities there must be a
cooperative initiative among educators, physicians, mid-level
providers, allied health care providers and the rural
communities.
(f) The Legislature further finds that the rural health
initiative and the Kellogg program have together implemented a
nationally acclaimed, highly successful effort to enable the
health professions schools to serve the rural and primary care
health needs of the state and should be continued as a single
program within the office of the vice chancellor for health
sciences.
§18B-16-3. Definitions.
For purposes of this article, and in addition to the
definitions set forth in section two, article one of this
chapter, the terms used in this article have the following
definitions ascribed to them:
(a) "Advisory panel" or "panel" means the West Virginia
rural health advisory panel created under section six of this
article.
(b) "Allied health care" means health care other than that
provided by physicians, nurses, dentists and mid-level providers
and includes, but is not limited to, care provided by clinical
laboratory personnel, physical therapists, occupational
therapists, respiratory therapists, medical records personnel,
dietetic personnel, radiologic personnel, speech-language-hearing
personnel and dental hygienists.
(c) "Mid-level provider" includes, but is not limited to,
advanced nurse practitioners, nurse-midwives and physician
assistants.
(d) "Office of community and rural health services" means
that agency, staff or office within the department of health and
human resources which has as its primary focus the delivery of
rural health care.
(e) "Primary care" means basic or general health care which
emphasizes the point when the patient first seeks assistance from
the medical care system and the care of the simpler and more
common illnesses. This type of care is generally rendered by
family practice physicians, general practice physicians, general internists, obstetricians, pediatricians, psychiatrists and mid-
level providers.
(f) "Primary health care education sites" or "sites",
whether the term is used in the plural or singular, means those
rural health care facilities established for the provision of
educational and clinical experiences pursuant to section seven of
this article.
(g) "Rural health care facilities" or "facilities", whether
the term is used in the plural or singular, means nonprofit,
free-standing primary care clinics in medically underserved or
health professional shortage areas and nonprofit rural hospitals
with one hundred or less licensed acute care beds located in a
nonstandard metropolitan statistical area.
(h) "Schools of medicine" means the West Virginia
university school of medicine, which is the school of health
sciences; the Marshall school of medicine, which is the Marshall
medical school; and the West Virginia school of osteopathic
medicine.
(i) "Vice chancellor" means the vice chancellor for health
sciences provided for under section six, article two of this
chapter.
§18B-16-4.
Establishment of rural health initiative; goals of
rural health initiative.
There is hereby established a rural health initiative under
the auspices of the board of trustees and under the direction and
administration of the vice chancellor. This initiative shall
combine the efforts of the rural health initiative as created by this article in the year one thousand nine hundred ninety-one,
and the Kellogg program as administered by the vice chancellor
before the effective date of this section. The goals of the
rural health initiative include, but are not limited to:
(a) The development of at least six primary health care
education sites;
(b) The establishment of satellite programs from the primary
health care education sites to provide additional opportunities
for students and medical residents to serve under role models in
rural areas;
(c) The provision of training to all medical students under
the direction of primary care physicians practicing in rural
areas;
(d) The provision of admission preferences for qualified
students entering primary care in needed specialties in
underserved areas;
(e) The creation of medical residency rotations in hospitals
and clinics in rural areas and the provision of incentives to
medical residents to accept the residencies at these hospitals
and clinics;
(f) The placement of mid-level providers in rural
communities and the provision of support to the mid-level
providers;
(g) The extension of rural hospital physician respite loan
programs to rural primary health care clinics;
(h) The development of innovative programs which enhance
student interest in rural health care opportunities;
(i) The increased placement of primary care physicians in
underserved areas;
(j) The increased retention of obstetrical providers and the
availability of prenatal care;
(k) The increased use of underserved areas of the state in
the educational process;
(l) An increase in the number of support services provided
to rural practitioners;
(m) An increase in the retention rate of graduates from West
Virginia medical schools, nursing schools and allied health care
education programs;
(n) The development of effective health promotion and
disease prevention programs to enhance wellness; and
(o) The establishment of primary health care education sites
which complement existing community health care resources and
which do not relocate the fundamental responsibility for health
care from the community to the board of trustees.
§18B-16-6. Creation of the West Virginia rural
health advisory
panel.
(a) The West Virginia rural health advisory panel is hereby
created and the rural health initiative advisory panel is hereby
terminated as of the first day of July, one thousand nine hundred
ninety-five. The advisory panel, which shall be appointed by the
governor after consulting with the vice chancellor, shall consist
of one community representative from each of the consortia of
primary health care education sites; five members shall be rural
health care providers, two of whom shall be representatives of rural health care facilities selected from such lists as may be
submitted by associations interested or involved in the provision
of rural health care, two of whom shall be physicians engaged in
the private practice of rural medicine, and one of whom shall be
an advanced nurse practitioner or a nurse midwife with experience
in rural health care delivery; the dean or designee from each of
the participating health sciences schools, ex officio; one
representative from private colleges; one representative from the
state college system; one site coordinator; the commissioner of
public health, ex officio; and the director of the office of
community and rural health services, ex officio. Except for the
ex officio members, members of the panel shall serve for
staggered three-year terms:
Provided, That one third of the
initial appointments shall be designated by the governor for one-
year terms and one third of the initial appointments shall be
designated by the governor for two-year terms.
Members of the advisory panel shall be reimbursed for the
cost of reasonable and necessary expenses actually incurred in
the performance of their duties:
Provided, That members of the
panel who are employed by the state of West Virginia shall not be
reimbursed for their expenses under the provisions of this
section.
(b) The functions and duties of the panel are to recommend
policies and procedures to the vice chancellor related to the
rural health initiative and to oversee and coordinate
implementation of those policies and procedures.
(c) Pursuant to the provisions of article ten, chapter four of this code, the West Virginia rural health advisory panel shall
continue to exist until the first day of July, two thousand one,
to allow for the completion of a preliminary performance review
by the joint committee on government operations.
(d) The advisory panel has the power and the duty to
recommend rural health care facilities to be established as
primary health care education sites. Such recommendation shall
be made to the vice chancellor in accordance with the criteria
set forth in section seven of this article. After review of the
proposals submitted to the vice chancellor by the schools of
medicine pursuant to section eight of this article, the panel's
recommendation shall include an estimation of the costs to be
allocated per site from available funds in the university of West
Virginia health sciences account in the line item designated for
rural health initiative site support.
(e) The advisory panel shall adopt guidelines regarding the
application by rural health care facilities for selection as
primary health care education sites and shall approve an
application form which provides the panel with sufficient
information to consider the criteria set forth in section eight
of this article. The guidelines and application shall be sent by
registered mail to each rural health care facility in the state
as soon as practicable after the effective date of this section.
(f) The advisory panel shall provide an ongoing evaluation
of the rural health initiative and shall make the reports
required under this article.
§18B-16-9. Accountability; reports and audit required.
(a) The vice chancellor, with the assistance of the advisory
panel, shall report in detail to the board of trustees on the
expenditure and planned expenditure of public funds to the
schools of medicine under section eight of this article. The
board of trustees shall report to the governor, the president of
the Senate and the speaker of the House of Delegates annually
prior to the first day of December as a part of the higher
education report cards required by section eight-a, article one
of this chapter.
(b) The vice chancellor, with the guidance and
recommendations of the advisory panel, shall develop additional
performance indicators, including, but not limited to: (1) An
analysis of the health care needs of the targeted areas; (2) the
number of persons served and the nature of the services provided;
(3) the number of full-time and part-time faculty, students,
interns and residents, by discipline, participating in the health
science and allied health care education programs; (4) the number
of health providers in each community served by primary health
care education sites; (5) the financial, social and health status
changes in each community served by primary health care education
sites; and (6) the extent to which the plans and policies of the
office of rural health and the health care planning commission
are being effectuated. The vice chancellor shall provide
information on the performance indicators to the board of
trustees for inclusion in the higher education accountability
report card for health sciences provided for in section eight-a,
article one of this chapter.
(c) The advisory panel shall report at least annually to the
joint legislative oversight commission on education
accountability created under section eleven, article three-a,
chapter twenty-nine-a of this code and to the area health
education centers subcommittee of the joint committee on
government and finance regarding the status of the rural health
care initiative, paying particular attention to the role of the
communities.
(d) The vice chancellor shall report at least annually to
the joint legislative oversight commission on education
accountability created under section eleven, article three-a,
chapter twenty-nine-a of this code and to the area health
education centers subcommittee of the joint committee on
government and finance regarding the status of the rural health
care initiative, paying particular attention to the role of the
schools of medicine.
(e) The board of trustees shall facilitate a meeting at
least quarterly for the chief administrators of each primary
health care education site established pursuant to this article
and each chief administrator at other rural health care
facilities providing educational and clinical experiences to
students, interns and residents at the state's schools of
medicine. The meetings shall commence no later than the first
day of July, one thousand nine hundred ninety-two, and shall be
for the purpose of discussing the status, efficiency and
effectiveness of the various programs and their operation and
recommending any changes to the board of trustees, which may include statutory recommendations to be made to the Legislature.
In addition to the reports otherwise required and commencing
with a report for the fiscal year beginning on the first day of
July, one thousand nine hundred ninety-one, the chief
administrators shall submit to the board of trustees an annual
evaluation of the extent to which the goals set forth in section
four of this article and other goals relating to collaborative
efforts between the schools of medicine and rural health care
facilities are being attained. Such report shall be forwarded
annually in its entirety to the governor, the president of the
Senate and the speaker of the House of Delegates no later than
the fifteenth day of January.
(f) The legislative auditor, at the direction of the joint
committee on government and finance, shall perform on an ongoing
basis a fiscal audit of the medical education components within
the university of West Virginia system, the state college system
and the rural health initiative for periodic review by the
Legislature.