H. B. 2119
(By Mr. Speaker (Mr. Chambers) and Delegate Ashley)
(By Request of the Executive)
[Introduced January 23, 1995; referred to the
Committee on Education then Finance.]
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,
relating to the West Virginia partnerships for rural health
education.
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 rural health
initiative advisory panel the West Virginia partnerships for
rural health education 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) "Health care planning commission" means the commission
created pursuant to article one-a, chapter sixteen of this code.
(d) (c) "Mid-level provider" includes, but is not limited
to, advanced nurse practitioners, nurse-midwives, and physician
assistants.
(e) (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.
(f) (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.
(g) (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.
(h) (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.
(i) (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.
(j) (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 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 partnerships for rural
health education panel.
(a) The rural health initiative advisory panel is hereby
created and shall be composed of eighteen members as follows:
(1) One member shall be the commissioner of the bureau of public
health, who shall chair the panel; (2) one member shall be a
representative of the office of rural health; (3) one member
shall be a representative of the health care planning commission;
(4) one member shall be a representative of the office of
community health services; (5) 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; (6) four members shall represent
consumers; (7) one member shall be a president of a private
college or university to represent the health education programs
at the state's private colleges and universities: Provided, That
the presidents of the various private colleges and universities shall select the member representing the private colleges and
universities and submit the name to the governor for his
appointment: Provided, however, That such member shall be a
nonvoting member; (8) one member shall be the president of the
West Virginia school of osteopathic medicine or a designee; (9)
one member shall be the vice president of the West Virginia
university school of medicine or a designee; (10) one member
shall be the vice president of the Marshall university school of
medicine or a designee; and (11) one member shall be a president
of a state college to represent the health education programs of
the state college system, selected by a vote of the presidents of
the state colleges. Those members representing state
institutions of higher education shall be ex officio, nonvoting
members of the panel.
The governor, with the advice and consent of the Senate,
shall appoint those individuals who are not members of the panel
by virtue of their office. The governor shall appoint those
members of the panel who represent health care providers and
consumers for staggered, three-year terms, and the resident
addresses of such members shall be geographically dispersed throughout the state. All successive appointments shall be for
three-year terms. After the initial appointment of the advisory
panel, any appointment to fill a vacancy shall be for the
unexpired term only.
The governor shall make all appointments within ten days of
the effective date of this article, and the vice chancellor shall
convene the advisory panel by the first day of December, one
thousand nine hundred ninety-one. Thereafter, the chair shall
schedule the meetings of the panel and notify members of such
meetings. The panel shall meet at least monthly until such time
as the initial recommendation has been forwarded to the vice
chancellor and at least quarterly thereafter or upon the call of
the chair.
(a) The West Virginia partnerships for rural health
education panel is hereby created and the rural health initiative
advisory panel is hereby terminated except that the rural health
initiative advisory panel may continue for such time until the
first day of September, one thousand nine hundred ninety-five, as
may be necessary for an orderly transition of responsibilities
and duties to the West Virginia partnerships for rural health education panel. The panel, which shall be appointed by the
governor, shall consist of one community representative from each
of the consortia of primary health care education sites as
designated by the vice chancellor from time to time; the dean or
designee from each of the participating health sciences schools,
ex officio; one representative nominated by private colleges and
approved by the vice chancellor; one representative nominated by
the state college system and approved by the vice chancellor; 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 vice chancellor for one-year terms and one
third of the initial appointments shall be designated by the vice
chancellor 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.
(b) (c) The advisory panel shall be terminated by the
provisions of article ten, chapter four of this code on the first
day of July, one thousand nine hundred
ninety-five ninety-nine,
unless sooner terminated or unless continued or reestablished
pursuant to that article.
(c) (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.
(d) (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.
(e) (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,
no later than the fifteenth day of February, one thousand nine hundred
ninety-two, the thirtieth day of June, one thousand nine hundred
ninety-two, the thirty-first day of December, one thousand nine
hundred ninety-two, and, thereafter 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 and performance review 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.
NOTE: The purpose of this bill is to continue two highly
acclaimed programs on rural health care as one program.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.