HB4607 SFA Weld #1 3-12
Senator Weld moved to amend the Health and Human Resources amendment on page one before the heading by striking out everything:
CHAPTER 9. HUMAN SERVICES.
ARTICLE 5. MISCELLANEOUS PROVISIONS.
(a) The Bureau for Medical Services shall develop, seek approval of, and implement a Medicaid state plan amendment as necessary and appropriate to effectuate a system of certified community behavioral health clinics (CCBHCs).
(b) The Bureau for Medical Services, in partnership with the Department of Health and Human Resources’ Bureau for Behavioral Health, shall establish a state certification system for CCBHCs in accordance with the following requirements:
(1) To the fullest extent practicable, the CCBHC system shall be consistent with the demonstration program established by Section 223 of the Protecting Access to Medicare Act of 2014 (P.L. 113-93, 42 U.S.C. 1396a note), as amended.
(2) Standards and methodologies for a prospective payment system shall be established to reimburse each CCBHC under the state Medicaid program on a predetermined, fixed amount per day for covered services rendered to each Medicaid beneficiary.
(3) A quality incentive payment system shall be established for those CCBHCs which achieve specific thresholds on performance metrics identified by the Bureau for Medical Services. Such quality incentive payments shall be in addition to the bundled prospective daily rate.
(4) The prospective payment rate for each CCBHC shall be adjusted tri-annually by the Medicare Economic Index as defined in Section 223 of Protecting Access to Medicare Act of 2014. In addition, the prospective payment rate shall allow for modifications based upon a change in scope for an individual CCBHC. Rate adjustments can be made upon request by the provider.
(5) Criteria shall be established to certify a facility as a CCBHC which, at a minimum, shall require each CCBHC to offer directly, or indirectly through formal referral relationships with other providers, the following services:
(A) Crisis mental health services, including 24-hour mobile crisis teams, emergency crisis intervention services, and crisis stabilization;
(B) Screening, assessment, and diagnosis, including risk assessment;
(C) Patient-centered treatment planning or similar processes, including risk assessment and crisis planning;
(D) Outpatient clinic primary care screening and monitoring of key health indicators and health risk;
(E) Targeted case management;
(F) Psychiatric rehabilitation services;
(G) Peer support and counselor services;
(H) Family support services; and
(I) Community-based mental health services, including mental health services for members of the armed forces and veterans.
(c) All nonprofit comprehensive community mental health centers, comprehensive intellectual disability facilities, as established by §27-2A-1 of this code, and all other providers set forth in the Medicaid state plan amendment shall be eligible to apply for certification as a CCBHC.
(d) The Bureau for Medical Services, in partnership with the Department of Health and Human Resources’ Bureau for Behavioral Health, shall establish any other procedures and standards as may be necessary for an eligible facility to apply for certification, become certified, and remain certified as a CCBHC, as set forth in the legislative rule developed pursuant to this section.
(e) The participation of any eligible facility in the CCBHC system shall be strictly voluntary. Nothing in this section shall require a facility that is eligible for certification as a CCBHC to apply for such certification;
CHAPTER 16. PUBLIC HEALTH.
§16-2D-8. Proposed health services that require a certificate of need.
(a) Except as provided in
§16-2D-9, §16-2D-10, and §16-2D-11 of this code, the following proposed health
services may not be acquired, offered, or developed within this state except
of and receipt of a certificate of need as provided by
(1) The construction, development, acquisition, or other establishment of a health care facility;
(2) The partial or total closure of a health care facility with which a capital expenditure is associated;
(3)(A) An obligation for a capital expenditure incurred by or on behalf of a health care facility in excess of the expenditure minimum; or
(B) An obligation for a capital expenditure incurred by a person to acquire a health care facility;
(4) An obligation for a capital expenditure is considered to be incurred by or on behalf of a health care facility:
(A) When a valid contract is entered into by or on behalf of the health care facility for the construction, acquisition, lease, or financing of a capital asset;
(B) When 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
(C) In the case of donated property, on the date on which the gift is completed under state law;
(5) A substantial change to the bed capacity of a health care facility with which a capital expenditure is associated;
(6) The addition of ventilator services by a hospital;
(7) The elimination of health services previously offered on a regular basis by or on behalf of a health care facility which is associated with a capital expenditure;
(8)(A) 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;
(B) If the change is associated with a previous capital expenditure for which a certificate of need was issued; and
(C) If the change will occur within two years after the date the activity which was associated with the previously approved capital expenditure was undertaken;
(9) The acquisition of major medical equipment;
(10) A substantial change in an approved health service for which a certificate of need is in effect;
(11) An expansion of the service area for hospice or home health agency regardless of the time period in which the expansion is contemplated or made; and
(12) The addition of health services offered by or on behalf of a health care facility which were not offered on a regular basis by or on behalf of the health care facility within the 12-month period prior to the time the services would be offered.
(b) The following health services are required to obtain a certificate of need regardless of the minimum expenditure:
developing, acquiring, or establishing a birthing center; (2) (1) Providing radiation therapy; (3) (2) Providing computed tomography; (4) (3) Providing positron emission tomography; (5) (4) Providing cardiac surgery; (6) (5) Providing fixed magnetic resonance
imaging; (7) (6) Providing comprehensive medical
rehabilitation; (8) (7) Establishing an ambulatory care center; (9) (8) Establishing an ambulatory surgical
center; (10) (9) Providing diagnostic imaging; (11) (10) Providing cardiac catheterization
services; (12) (11) Constructing, developing, acquiring, or
establishing kidney disease treatment centers, including freestanding
hemodialysis units; (13) (12)
Providing megavoltage radiation therapy; (14) (13) Providing surgical services; (15) (14) Establishing operating rooms; (16) (15) Adding acute care beds; (17) (16) Providing intellectual developmental
disabilities services; (18) (17) Providing organ and tissue transplants; (19) (18) Establishing an intermediate care
facility for individuals with intellectual disabilities; (20) (19) Providing inpatient services; (21) (20) Providing hospice services; (22) (21) Establishing a home health agency;
(22) Establishing an opioid treatment program;
(23) (23) Providing
personal care services; and (24) (24)(A) Establishing no more than six, four-bed
transitional intermediate care facilities: Provided, That none of the
four-bed sites shall be within five miles of another or adjacent to another
behavioral health facility. This subdivision terminates upon the approval of
the sixth four-bed intermediate care facility;
(B) Only individuals living in more restrictive institutional settings, in similar settings covered by state-only dollars, or at risk of being institutionalized will be given the choice to move, and they will be placed on the Individuals with Intellectual and Developmental Disabilities (IDD) Waiver Managed Enrollment List. Individuals already on the IDD Waiver Managed Enrollment List who live in a hospital or are in an out-of-state placement will continue to progress toward home- and community-based waiver status and will also be considered for all other community-based options including, but not limited to, specialized family care and personal care.
(C) The department shall work to find the most integrated placement based upon an individualized assessment. Individuals already on the IDD waiver will not be considered for placement in the 24 new intermediate care beds.
(D) A monitoring committee of not more than 10 members, including a designee of Mountain State Justice, a designee of Disability Rights of West Virginia, a designee of the Statewide Independent Living Council, two members or family of members of the IDD waiver, the Developmental Disabilities Council, the Commissioner of the Bureau of Health and Health Facilities, the Commissioner of the Bureau for Medical Services, and the Commissioner of the Bureau for Children and Families. The secretary of the department shall chair the first meeting of the committee at which time the members shall elect a chairperson. The monitoring committee shall provide guidance on the department’s transitional plans for residents in the 24 intermediate care facility beds and monitor progress toward home- and community-based waiver status and/or utilizing other community-based options and securing the most integrated setting for each individual.
(E) Any savings resulting from individuals moving from more expensive institutional care or out-of-state placements shall be reinvested into home- and community-based services for individuals with intellectual developmental disabilities.
(c) A certificate of need previously approved under this article remains in effect unless revoked by the authority.
§16-2D-9. Health services that cannot be developed.
Notwithstanding §16-2D-8 and §16-2D-11 of this code, these health services require a certificate of need but the authority may not issue a certificate of need to:
(1) A health care facility adding intermediate care or skilled nursing beds to its current licensed bed complement, except as provided in §16-2D-11(c)(23) of this code;
(2) A person developing, constructing, or replacing a skilled nursing facility except in the case of facilities designed to replace existing beds in existing facilities that may soon be deemed unsafe or facilities utilizing existing licensed beds from existing facilities which are designed to meet the changing health care delivery system; and
beds in an intermediate care facility for individuals with an intellectual
disability, except that prohibition does not apply to an intermediate care
facility for individuals with intellectual disabilities beds approved under the
cCircuit cCourt order of August 3,
1989, civil action number MISC-81-585 issued in the case of E.H. v. Matin, 168
W.V. 248, 284 S.E. 2d 232 (1981) including the 24 beds provided in §16-2D-8(b)(24)
of this code: Provided, That when an existing intermediate care facility for individuals
with intellectual disabilities voluntarily or involuntarily permanently closes,
as determined by the Office of Health Facility License and Certification, those
beds shall revert to the Health Care Authority to be redistributed to another
provider as determined by a Health Care Authority policy. and (4) An opioid treatment
eight§16-2D-8 of this code, a person may provide the following
health services without obtaining a certificate of need or applying to the
authority for approval:
(1) The creation of a private office of one or more licensed health professionals to practice in this state pursuant to chapter thirty of this code;
(2) Dispensaries and
first-aid stations located within business or industrial establishments
maintained solely for the use of employees that does not contain inpatient or
resident beds for patients or employees who generally remain in the facility
for more than
twenty-four 24 hours;
(3) A place that provides remedial care or treatment of residents or patients conducted only for those who rely solely upon treatment by prayer or spiritual means in accordance with the creed or tenets of any recognized church or religious denomination;
(5) A facility owned or
operated by one or more health professionals authorized or organized pursuant
to chapter thirty or ambulatory health care facility which offers laboratory
services or diagnostic imaging to patients regardless of the cost associated
with the proposal. To qualify for this exemption
percent of the laboratory services are for the patients of the practice or
ambulatory health care facility of the total laboratory services performed and seventy-five
75 percent of diagnostic imaging services are for the patients of the
practice or ambulatory health care facility of the total imaging services
performed. The authority may, at any time, request from the entity information
concerning the number of patients who have been provided laboratory services or
(6)(A) Notwithstanding the
section seventeen of this article §16-2D-17 of this
code, any hospital that holds a valid certificate of need issued pursuant
to this article, may transfer that certificate of need to a person purchasing
that hospital, or all or substantially all of its assets, if the hospital is
financially distressed. A hospital is financially distressed if, at the time of
(i) It has filed a petition for voluntary bankruptcy;
(ii) It has been the subject of an involuntary petition for bankruptcy;
(iii) It is in receivership;
(iv) It is operating under a forbearance agreement with one or more of its major creditors;
(v) It is in default of its obligations to pay one or more of its major creditors and is in violation of the material, substantive terms of its debt instruments with one or more of its major creditors; or
(vi) It is insolvent: evidenced by balance sheet insolvency and/or the inability to pay its debts as they come due in the ordinary course of business.
(B) A financially
distressed hospital which is being purchased pursuant to the provisions of this
subsection shall give notice to the authority of the sale
days prior to the closing of the transaction and shall file simultaneous with
that notice evidence of its financial status. The financial status or
distressed condition of a hospital shall be evidenced by the filing of any of
(i) A copy of a forbearance agreement;
(ii) A copy of a petition for voluntary or involuntary bankruptcy;
(iii) Written evidence of receivership, or
(iv) Documentation establishing the requirements of subparagraph (v) or (vi), paragraph (A) of this subdivision. The names of creditors may be redacted by the filing party.
(C) Any substantial change to the capacity of services offered in that hospital made subsequent to that transaction would remain subject to the requirements for the issuance of a certificate of need as otherwise set forth in this article.
(D) Any person purchasing a financially distressed hospital, or all or substantially all of its assets, that has applied for a certificate of need after January 1, 2017, shall qualify for an exemption from certificate of need;
(7) The acquisition by a
qualified hospital which is party to an approved cooperative agreement as
section twenty-eight, article twenty-nine-b, chapter sixteen
§16-29B-28 of this code, of a hospital located within a distance of
twenty highway miles of the main campus of the qualified hospital; and
(8) The acquisition by a hospital of a physician practice group which owns an ambulatory surgical center as defined in this article; and
(9) Constructing, developing, acquiring, or establishing a birthing center.
§16-2D-11. Exemptions from Certificate of Need which require the submission of information to the authority.
(a) To obtain an exemption under this section a person shall:
(1) File an exemption application; and
(2) Provide a statement detailing which exemption applies and the circumstances justifying the exemption.
eight §16-2D-8 of this code and ten §16-2D-10 of
this code and except as provided in
section nine of this article, the Legislature finds that a need exists and
these health services are exempt from the certificate of need process:
(1) The acquisition and
utilization of one computed tomography scanner with a purchase price up to
$750,000 that is installed in a private office practice where at minimum
75 percent of the scans are performed on the patients of the practice.
The private office practice shall obtain and maintain accreditation from the
American College of Radiology prior to, and at all times during, the offering
of this service. The authority may at any time request from the private office
practice information relating to the number of patients who have been provided scans
and proof of active and continuous accreditation from the American College of
Radiology. If a physician owns or operates a private office practice in more
than one location, this exemption shall only apply to the physician’s primary
place of business, and if a physician wants to expand the offering of this
service to include more than one computed topography scanner, he or she shall
be required to obtain a certificate of need prior to expanding this service.
All current certificates of need issued for computed tomography services, with
a required percentage threshold of scans to be performed on patients of the
practice in excess of seventy-five 75 percent, shall be reduced
to seventy-five 75 percent:
Provided, That these limitations on
the exemption for a private office practice with more than one location shall
not apply to a private office practice with more than twenty locations in the
state on April 8, 2017.
(A) A birthing
center established by a nonprofit primary care center that has a community
board and provides primary care services to people in their community without
regard to ability to pay; or (B) A birthing center
established by a nonprofit hospital with less than one hundred licensed acute
care beds. (i) To qualify for this
exemption, an applicant shall be located in an area that is underserved with
respect to low-risk obstetrical services; and (ii) Provide a proposed
health service area. (3) (A) A health care facility acquiring major medical
equipment, adding health services, or obligating a capital expenditure to be
used solely for research;
(B) To qualify for this exemption, the health care facility shall show that the acquisition, offering, or obligation will not:
(i) Affect the charges of the facility for the provision of medical or other patient care services other than the services which are included in the research;
(ii) Result in a substantial change to the bed capacity of the facility; or
(iii) Result in a substantial change to the health services of the facility.
(C) For purposes of this subdivision, the term “solely for research” includes patient care provided on an occasional and irregular basis and not as part of a research program;
(4) (3) The obligation of a capital expenditure to
acquire, either by purchase, lease, or comparable arrangement, the real
property, equipment, or operations of a skilled nursing facility: Provided, That a skilled nursing facility
developed pursuant to subdivision ( 17)(15) of this section and
subsequently acquired pursuant to this subdivision may not transfer or sell any
of the skilled nursing home beds of the acquired skilled nursing facility until
the skilled nursing facility has been in operation for at least ten 10
years. (5) (4) Shared health services between two or more
hospitals licensed in West Virginia providing health services made available
through existing technology that can reasonably be mobile. This exemption does
not include providing mobile cardiac catheterization; (6) (5) The acquisition, development, or
establishment of a certified interoperable electronic health record or
electronic medical record system; (7) (6) The addition of forensic beds in a health
care facility; (8) (7) A behavioral health service selected by
the Department of Health and Human Resources in response to its request for
application for services intended to return children currently placed in
out-of-state facilities to the state or to prevent placement of children in
out-of-state facilities is not subject to a certificate of need; (9) (8) The replacement of major medical equipment
with like equipment, only if the replacement major medical equipment cost is
more than the expenditure minimum; (10) (9) Renovations within a hospital, only if the
renovation cost is more than the expenditure minimum. The renovations may not
expand the health care facility’s current square footage, incur a substantial
change to the health services, or a substantial change to the bed capacity; (11) (10) Renovations to a skilled nursing
facility; (12) (11) The donation of major medical equipment
to replace like equipment for which a certificate of need has been issued and
the replacement does not result in a substantial change to health services.
This exemption does not include the donation of major medical equipment made to
a health care facility by a related organization; (13) (12) A person providing specialized foster
care personal care services to one individual and those services are delivered
in the provider’s home; (14) (13) A hospital converting the use of beds
except a hospital may not convert a bed to a skilled nursing home bed and
conversion of beds may not result in a substantial change to health services
provided by the hospital; (15) (14) The construction, renovation, maintenance,
or operation of a state-owned veterans skilled nursing facilities established
pursuant to the provisions of article one-b of this chapter §16-1B-1 et
seq. of this code; (16) (15) To
develop and operate a skilled nursing facility with no more than thirty-six
36 beds in a county that currently is without a skilled nursing
facility; (17) (16) A critical access hospital, designated by
the state as a critical access hospital, after meeting all federal eligibility
criteria, previously licensed as a hospital and subsequently closed, if it
reopens within ten 10 years of its closure; (18) (17) The establishing of a heath care facility
or offering of health services for children under one year of age suffering
from Neonatal Abstinence Syndrome; (19) (18) The construction, development,
acquisition, or other establishment of community mental health and intellectual
disability facility; (20) (19) Providing behavioral health facilities
and services; (21) (20) The construction, development,
acquisition, or other establishment of kidney disease treatment centers,
including freestanding hemodialysis units but only to a medically underserved
population; (22) (21) The transfer, purchase, or sale of
intermediate care or skilled nursing beds from a skilled nursing facility or a
skilled nursing unit of an acute care hospital to a skilled nursing facility
providing intermediate care and skilled nursing services. The Department of
Health and Human Resources may not create a policy which limits the transfer,
purchase, or sale of intermediate care or skilled nursing beds from a skilled
nursing facility or a skilled nursing unit of an acute care hospital. The
transferred beds shall retain the same certification status that existed at the
nursing home or hospital skilled nursing unit from which they were acquired.
If construction is required to place the transferred beds into the acquiring
nursing home, the acquiring nursing home has one year from the date of purchase
to commence construction; (23) (22) The construction, development,
acquisition, or other establishment by a health care facility of a nonhealth
related project, only if the nonhealth related project cost is more than the
expenditure minimum; (24) (23) The construction, development,
acquisition, or other establishment of an alcohol or drug treatment facility
and drug and alcohol treatment services unless the construction, development,
acquisition or other establishment is an opioid treatment facility or programs
as set forth in subdivision (4) (22) of section nine of this
article; (25) (24) Assisted living facilities and services; (26) (25) The creation, construction, acquisition,
or expansion of a community-based nonprofit organization with a community board
that provides or will provide primary care services to people without regard to
ability to pay and receives approval from the Health Resources and Services
Administration; and (27) (26) The acquisition and utilization of one
computed tomography scanner and/or one magnetic resonance imaging scanner with
a purchase price of up to $750,000 by a hospital.
§16-5Y-12. Moratorium; certificate of need.