HB2266 S H&HR AM #1
Dellinger 7965
The Committee on Health and Human Resources moved to amend the bill by striking out everything after the enacting clause and inserting in lieu thereof the following:
§9-5-12. Medicaid program; maternity and infant care.
(a) The Legislature
finds that high rates of infant mortality and morbidity are costly to the state
in terms of human suffering and of expenditures for long-term
institutionalization, special education, and medical care. It is well
documented that appropriate care during pregnancy and delivery can prevent many
of the expensive, disabling problems our children experience. There exists a
crisis in this state relating to the availability of obstetrical services,
particularly to patients in rural areas, and to the cost patients must pay for
obstetrical services. The availability of obstetrical service for Medicaid
patients enables these patients to receive quality medical care and to give
birth to healthier babies and, consequently, improve the health status of the
next generation.
The Legislature further
recognizes that public and private insurance mechanisms remain inadequate, and
poor and middle-income women and children are among the most likely to be
without insurance. Generally, low-income, uninsured children receive half as
much health care as their insured counterparts. The state is now investing
millions to care for sick infants whose deaths and disabilities could have been
avoided.
It is the intent of the
Legislature that the Department of Health and Human Resources participate in
the Medicaid program for indigent children and pregnant women established by
Congress under the Consolidated Omnibus Budget Reconciliation Act (COBRA),
Public Law 99-272, the Sixth Omnibus Budget Reconciliation Act (SOBRA), Public
Law 99-504, and the Omnibus Budget Reconciliation Act (OBRA), Public Law
100-203.
(b) (a) The department shall:
(1) Extend Medicaid
coverage to pregnant women and their newborn infants to 185 percent of the
federal poverty level and to provide coverage up to 60 days 1-year
postpartum care, effective July 1, 2019, 2021 or as soon as
federal approval has occurred.
(2) As provided under COBRA,
SOBRA, and OBRA the Consolidated Omnibus Budget Reconciliation Act
(COBRA), Public Law 99-272, the Sixth Omnibus Budget Reconciliation Act
(SOBRA), Public Law 99-509, and the Omnibus Budget Reconciliation Act (OBRA),
Public Law 100-123, effective July 1, 1988, infants shall be included under
Medicaid coverage with all children eligible for Medicaid coverage born after
October 1, 1983, whose family incomes are at or below 100 percent of the
federal poverty level and continuing until such children reach the age of eight
years.
(3) Elect the federal options provided under COBRA, SOBRA, and OBRA impacting pregnant women and children below the poverty level: Provided, That no provision in this article shall restrict the department in exercising new options provided by or to be in compliance with new federal legislation that further expands eligibility for children and pregnant women.
(4) The department is responsible for the implementation and program design for a maternal and infant health care system to reduce infant mortality in West Virginia. The health system design shall include quality assurance measures, case management, and patient outreach activities. The department shall assume responsibility for claims processing in accordance with established fee schedules and financial aspects of the program necessary to receive available federal dollars and to meet federal rules and regulations.
(5) Beginning July 1,
1988, the The department shall increase to no less than $600
the reimbursement rates under the Medicaid program for prenatal care, delivery,
and post-partum care.
(c) (b) In order to be in compliance with the
provisions of OBRA through rules and regulations, the department shall ensure
that pregnant women and children whose incomes are above the Aid to Families
and Dependent Children (AFDC) payment level are not required to apply for
entitlements under the AFDC program as a condition of eligibility for Medicaid
coverage. Further, the department shall develop a short, simplified pregnancy/pediatric
application of no more than three pages, paralleling the simplified OBRA
standards.
(d) (c) Any woman who establishes eligibility
under this section shall continue to be treated as an eligible individual
without regard to any change in income of the family of which she is a member
until the end of the 60-day 1 year period beginning on the last
day of her pregnancy.
(e) (d) The department shall make payment for
tubal ligation without requiring at least 30 days between the date of informed
consent and the date of the tubal ligation procedure.
Adopted
Rejected