Senate Bill No. 232
(By Senator Hunter)
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[Introduced March 4, 1997; referred to the Committee
on Health and Human Resources; and then to the Committee on
Finance.]
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A BILL to amend and reenact section four, article four-b, chapter
nine of the code of West Virginia, one thousand nine hundred
thirty-one, as amended, relating to making nurse
practitioners entitled to receive medicaid payments.
Be it enacted by the Legislature of West Virginia:
That section four, article four-b, chapter nine of the code
of West Virginia, one thousand nine hundred thirty-one, as
amended, be amended and reenacted to read as follows:
ARTICLE 4B. PHYSICIAN/MEDICAL PRACTITIONER PROVIDER MEDICAID
ACT.
§9-4B-4. Powers and duties.
(a) The board shall:
(1) Develop and recommend a reasonable physician/medical
practitioner provider
and nurse practitioner's 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. In identifying basic primary
and preventive health care services and in accordance with
applicable federal medicaid laws, the board may consider factors,
including, but not limited to, services defined and prioritized
by the basic services task force of the health care planning
commission in its report issued in December of the year one
thousand nine hundred ninety-two; and minimum benefits and
coverages for policies of insurance as set forth in section
fifteen, article fifteen, chapter thirty-three of this code and
section four, article sixteen-c of said chapter and rules of the
insurance commissioner promulgated thereunder. If the single
state agency approves the fee schedule, it shall implement the
physician/medical practitioner provider
and nurse practitioner's
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
and nurse practitioners who
provide services.
(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. 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.
NOTE: The purpose of this bill is to make nurse
practitioners entitled to receive medicaid payments.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new language
that would be added.
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