Senate Bill No. 54
(By Senators Burdette, Mr. President, and Boley,
By Request of the Executive)
____________
[Introduced January 20, 1994; referred to the Committee
on Health and Human Resources; and then to the Committee
on Finance.]
____________
A BILL to repeal section ten-b, article one, chapter sixteen of
the code of West Virginia, one thousand nine hundred thirty-
one, as amended; to repeal article one-a of said chapter; to
repeal articles five, eight, nine and eleven, chapter
twenty-six of said code; to repeal section one, article two,
chapter twenty-seven of said code; to amend said code by
adding thereto a new chapter, designated chapter sixteen-a;
to amend and reenact section one, article three, chapter
eighteen-c of said code; to further amend said article by
adding thereto two new sections, designated sections three
and four; to amend and reenact section fifteen, article one,
chapter thirty of said code; and to further amend said
article by adding thereto a new section, designated section
seventeen, all relating to state health care system and the
restructuring thereof, including, but not limited to, the
creation of a state health care authority; legislative
findings; legislative intent; definitions; creating West
Virginia health care authority; setting forth powers of
health care authority; providing for executive committee of
directors of health care authority; specifying various
actions relating to health and health care for which health
care authority shall be responsible; requiring health care
authority to update state health plan; requiring certain
actions by state health programs and departments managing
state health facilities; establishing an executive secretary
of health care licensing boards and task force for
implementing improvements and staff consolidation in
licensing board system; requiring health care authority to
develop plan for long-term care in state and to develop
health-promotion programs; creating public health system
advisory council; focusing public health on core functions
and population-based services; requiring health care
authority to develop system for certifying health care
networks and exempting from coverage of federal and state
antitrust laws; requiring health care authority to develop
an information system to provide basis for reform;
establishing rural health loan program and rural health
scholars program; continuing office of executive secretary
of health professional licensing boards; and protecting from
liability any member of certain professional groups who
reports or otherwise provides evidence to the governingboard of such reporting person's profession, of the
negligence, impairment or incompetence of another member of
such profession, except in cases involving actual malice.
Be it enacted by the Legislature of West Virginia:
That section ten-b, article one, chapter sixteen of the code
of West Virginia, one thousand nine hundred thirty-one, as
amended, be repealed; that article one-a of said chapter be
repealed; that articles five, eight, nine and eleven, chapter
twenty-six of said code be repealed; that section one, article
two, chapter twenty-seven of said code be repealed; that said
code be amended by adding thereto a new chapter, designated
chapter sixteen-a; that section one, article three, chapter
eighteen-c of said code be amended and reenacted; that said
article be further amended by adding thereto two new sections,
designated sections three and four; that section fifteen, article
one, chapter thirty of said code be amended and reenacted; and
that said article be further amended by adding thereto a new
section, designated section seventeen, all to read as follows:
CHAPTER 16A. WEST VIRGINIA HEALTH CARE ACCESS
AND REFORM ACT OF 1994.
ARTICLE 1. GENERAL PROVISIONS.
§16A-1-1. Short title.
This chapter shall be known and may be cited as the "West
Virginia Health Care Access and Reform Act of 1994".
§16A-1-2. Legislative findings.
The Legislature hereby finds and declares that:
(a) West Virginia citizens face extreme financial and
medical risk because the state's and nation's existing health
care system does not provide adequate and appropriate access to
affordable health care services.
(b) West Virginia's business and taxpayers are burdened with
skyrocketing health care costs that drain public revenues and
place our private sector at a competitive disadvantage.
(c) Too many West Virginia communities do not have a
sufficient number of health professionals to provide the primary
and preventive care services needed by their communities. Forty-
three West Virginia counties have been designated as having
primary care health professional shortage areas.
(d) West Virginia's citizens suffer from some of the worst
health conditions in the country, with extremely high rates of
heart disease, cancer, diabetes, hypertension, smoking and
obesity.
(e) Change in West Virginia's health care system is
inevitable, being demanded by the public, by anticipated federal
legislation and by marketplace forces.
(f) The absence of a single point of accountability,
expertise and authority to manage West Virginia's health care
system undermines efforts to implement comprehensive and cost
effective health care reform strategies to provide quality,
affordable health care services for all West Virginians.
§16A-1-3. Legislative intent.
It is the intent of the Legislature that all actions takenpursuant to this act serve the following core set of health care
reform principles, subject to available funds:
(a) That all persons in the state have access to quality
health care services without reliance on uncompensated care or
unreimbursed services;
(b) That the state have strong regulatory and market
mechanisms to control rising health care costs for all payors on
an equitable basis;
(c) That systems of primary and preventive care services
exist for all persons on the community level, integrated with
regional and statewide sources of secondary and tertiary care;
(d) That health care consumers be able to choose between
different sources, methods, and providers of health care
services;
(e) That incentives and other mechanisms encourage West
Virginians to practice healthy lifestyles and to address the
state's relatively poor health status;
(f) That health care providers be reimbursed with an
equitable, competitive and timely system that minimizes
administrative costs and eliminates the need for health care
providers to differentiate among consumers based on their source
of payment;
(g) That health care providers be able to choose their
practice setting while being given options and incentives to
participate in cost effective systems of health care services.
§16A-1-4. Definitions.
For purposes of this chapter:
(a) "Authority" means the West Virginia health care
authority established by section one, article two of this
chapter.
(b) "Capitated health system" means a health services system
which provides its enrollees with a package of health services,
directly in its own clinical setting, or through contractual
arrangements, for a predetermined, prepaid fee which does not
change with the nature or extent of services provided.
(c) "Health care network" means a locally based organization
of health care, education and support service providers, which
promotes a cooperative and collaborative approach to the delivery
of health care services and provides for the complete range of
health care and, in some cases, social needs of its patients, and
which is planned, established and operated on a community level
within the framework of a state plan.
(d) "Certificate of need" means certificate of need as
described in article two-d, chapter sixteen of this code.
(e) "Certificate of need allocation" means the maximum
aggregate principal amount of certificates of need allocated by
the authority to a particular class of institutional health
services, as defined in article two-d, chapter sixteen of this
code, in a particular area during a calendar year, all in
accordance with section five, article four of this chapter.
(f) "Cost containment" means measures designed to control
and reduce increases in health care expenditures.
(g) "Expenditure target" means a budget developed for
aggregate health care spending within a specified time period.
(h) "Global budget" means an annually set or negotiated cap
on total health care expenditures. A global budget may apply to
a region, a population, a group of providers, a particular
hospital or a health plan responsible for the comprehensive care
of its members.
(i) "Health" means both physical and mental health.
(j) "Health care facility" means any facility, including,
but not limited to, hospitals, ambulatory surgical facilities,
nursing homes, mental health centers and primary care clinics
designated as such by rule of the authority:
Provided, That such
designation may be different for different purposes provided by
this chapter.
(k) "Health care provider" means any person, facility or
institution, including, but not limited to, a person, facility or
institution licensed, certified or authorized by law to provide
health care services in this state, designated as such by rule of
the authority:
Provided, That such designation may be different
for different purposes provided by this chapter.
(l) "Health care services" means any services delivered to
a person to promote healthful living, maintain health or
stability of chronic conditions, treat illness, injury or disease
or restore function, including, but not limited to, health
promotion and education, primary care, secondary care and
tertiary care.
(m) "Health education" means any combination of learning
opportunities designed to facilitate voluntary adaptations of
behavior conducive to health.
(n) "Health maintenance organization" means an organization
which provides its enrollees with a package of health services,
directly in its own clinical setting, or through contractual
arrangements, for a predetermined, prepaid fee which does not
change with the nature or extent of services provided, and which
organization complies with applicable provisions of this code,
including, but not limited to, article twenty-five-a, chapter
thirty-three of this code.
(o) "Health promotion" means any combination of health
education and related organizational, political and economic
interventions designed to facilitate behavioral and environmental
adaptations that will improve or protect health.
(p) "Health services" means services, including drugs and
durable medical equipment, delivered to individuals and families
by a wide range of health professionals that may be preventive,
diagnostic, curative, restorative or palliative. Health services
may also be directed to the entire population or communities.
This latter category of services includes prevention and control
of communicable diseases, community health protection, and a wide
range of health promotion and education activities in
communities, schools and workplaces.
(q) "Long-term care" means the health care, personal care
and social services required by persons who have lost, or neveracquired, some degree of functional capacity, delivered on a
long-term basis.
(r) "Managed care" means a system of comprehensive and
coordinated health care, which includes care management, quality
assurance, utilization review and similar measures to ensure
appropriate, high quality health care and the appropriate use of
limited resources and containment of costs.
(s) "Medicaid" means the state and federal program that
provides reimbursement for health care services for eligible
persons and families.
(t) "Medicare" means the federal program administered by the
United States social security administration that covers the
medical care of patients over age sixty-five and certain
qualified persons under age sixty-five.
(u) "Payor" means public, private, governmental and
nongovernmental payors or purchasers of health care services, all
in conformance with federal laws, rules and regulations.
(v) "Practice guideline" means a systematically developed
statement designed to assist health care providers and patients
to make decisions about appropriate health care for specific
clinical conditions.
(w) "Preventive care" means actions and programs undertaken
to prevent disease or its consequences, including, without
limitation, health care programs such as immunizations aimed at
warding off illnesses; early detection of diseases, such as pap
smears; to inhibit further deterioration of the body, such asexercise or prophylactic surgery; to promote health through
altering behavior, such as health education programs; and to
improve the healthfulness of the environment.
(x) "Primary care" means health care delivery that
emphasizes first contact care and assumes overall and ongoing
responsibility for a person in health promotion, disease
prevention, health maintenance, diagnosis and treatment of
illness and injury more simple or common than would be treated
with secondary or tertiary care, restorative care and management
of chronic care. Primary care involves a relationship between a
patient and primary care provider or a primary care provider
team, which seeks to achieve comprehensive coordination of the
patient's health care, including the educational, behavioral,
biological and social aspects thereof. It is a patient-oriented
approach that emphasizes the continuity of comprehensive care
over the full spectrum of health services, beginning with patient
assessment, wellness and prevention and extending through health
management, lifestyle modification, health education and care
management of needed services. The primary care provider is the
patient's advocate within the health care delivery system. The
appropriate use of consultants, specialists and community and
other resources is an integral function of effective primary
care.
(y) "Public health" means that broad segment of health the
mission of which is to fulfill society's interest in assuring
conditions in which people can be healthy; involves organizedcommunity efforts to prevent disease and to promote health, based
on epidemiology; and encompasses both activities undertaken
within the formal structure of government and the associated
efforts of private and voluntary organizations and individuals.
The principal functions of public health are assessment, policy
development and assurance of a healthful natural environment
rather than the provision of individualized health services.
(z) "Quality assurance" means a program to measure and
monitor the quality of care rendered by a group or institution
and includes procedures to remedy deficiencies or problems.(aa)
"State agency" means any division, agency, board, department,
authority, bureau, commission or any other state governmental
body.
(bb) "State health facility" means any state-operated
treatment facility named in article two, chapter twenty-seven of
this code, any acute or extended care facility named in chapter
twenty-six of this code, and other state-owned health facility
hereafter created, relating to the provision of health care
services of any type.
(cc) "State health plan" means the plan, as modified or
replaced by the authority, establishing the guidelines, goals and
objectives, and other mechanisms by and through which state
health programs serve the provisions of this chapter.
(dd) "State health programs" means those state agencies
determined by the health care authority to have policies,
programs, services, duties or responsibilities relating to healthor health care. At a minimum, such programs shall include the
department of health and human resources, the health care cost
review authority, the division of workers compensation, the
public employees' insurance agency, the division of insurance,
and the division of rehabilitation services.
§16A-1-5. West Virginia health care authority created;
composition; appointment of members; terms of office;
conflict of interest provisions; expenses and compensation;
meetings; quorum; records.
(a) There is hereby created the West Virginia health care
authority as a governmental instrumentality and a body corporate
with the powers and duties set forth in this chapter.
(b) The authority shall consist of five members appointed by
the governor with the advice and consent of the Senate. The
chair shall be designated by the governor. There shall be one
member from each congressional district existing on the effective
date of passage of this act and two at large members who are not
members of the same congressional district. No more than three
of the members shall be from the same political party. The terms
of each member shall be for six years, except that the governor
shall designate one of the initial members to serve an initial
term ending the first day of July, one thousand nine hundred
ninety-six, and two of the initial members to serve an initial
term ending the first day of July, one thousand nine hundred
ninety-eight. The governor may remove a member of the authority
only for cause as provided in article six, chapter six of thiscode. Any member appointed to fill a vacancy occurring prior to
the expiration of a term shall be appointed only for the
remainder of the unexpired term. The governor shall make the
initial appointments to the board no later than the first day of
June, one thousand nine hundred ninety-four. Before entering
upon his or her duties as a member of the authority, each member
shall comply with the requirements of article one, chapter six of
this code.
(c) An individual may not serve as a member of the
authority, if the individual, or the individual's spouse, is one
of the following:
(1) A health care provider;
(2) An individual who is an employee or member of the board
of directors of, has a five percent or greater ownership interest
in, or derives more than one thousand dollars per year
substantial income from, a health care provider, health plan,
pharmaceutical company, or a supplier of medical equipment,
devices or services;
(3) A person who derives more than one thousand dollars per
year from the provision of health care;
(4) (i) A member or employee of an association, law firm, or
other institution or organization that represents the interests
of one or more health care providers, health plan or others
involved in the health care field, or (ii) an individual who
practices as a professional in an area involving health care.
(d) Members of the authority shall be paid a per diem of twohundred dollars and actual expenses for days, or proportionately
for half days, traveling to, from or engaged in authority
business.
(e) A majority of the members of the authority shall
constitute a quorum, and a quorum must be present for the
authority to conduct business. The affirmative vote of at least
the majority of the members present is necessary for any action
taken by vote of the authority. No vacancy in the membership of
the authority impairs the rights of a quorum by vote to exercise
all the rights and perform all the duties of the authority.
Notwithstanding any other provision in this code to the contrary,
the authority, or any members thereof, may meet with the staff of
the authority for the purposes of receiving and analyzing data,
reports, and other information and discussing matter for which
the authority is responsible, and all such meetings are exempt
from the requirements of section three, article nine-a, chapter
six of this code:
Provided, That no decisions requiring a vote
of the authority may be made at such a meeting and all other
meetings of the authority shall be conducted in accordance with
the provisions of said article.
§16A-1-6. Executive committee.
(a) The authority shall appoint a three-person full-time
executive committee, consisting of a director of administration,
a director of research and development, and a director of
consumer affairs, to manage the operations of the authority:
(1) The director of administration shall be the chiefoperations officer of the authority and shall be responsible for
coordinating the ongoing efforts of state health programs to
achieve the health care reform principles defined in section
three of this article and as provided for in the state health
plan. The director of administration shall also be responsible
for gathering and evaluating provider concerns about the health
care system in the state and for developing strategies to respond
to those concerns.
(2) The director of research and development shall be
responsible for overseeing all data collection and information
system reforms, drafting amendments to the state health plan and
proposed health care reform legislation, and other health care
reform planning and evaluation functions.
(3) The director of consumer rights shall be responsible for
evaluating consumer concerns about the quality and accessibility
of health care services in the state and developing strategies to
respond to those concerns.
(b) Each director shall report directly to the authority and
may be removed only from his or her position only by majority
vote of the authority.
§16A-1-7. Powers of the authority generally.
(a) The authority has the following general administrative
powers:
(1) To acquire, own, hold and dispose of property, whether
real, personal, tangible, intangible or mixed.
(2) To enter into leases and lease-purchase agreements,whether as the lessee or lessor.
(3) To make bylaws and to develop and implement procedures
governing the internal operation and administration of the
authority, including guidelines for purchasing and performing its
duties under this chapter involving the expenditure of funds.
(4) To adopt an official seal.
(5) To employ staff, which shall be exempt from the
provisions of article six, chapter twenty-nine of this code.
(6) To make contracts of every kind and nature, including,
but not limited to, interstate agreements or compacts, and to
execute all instruments necessary or convenient for performing
its duties hereunder.
(7) To solicit, accept and use gifts, bequests or donations
of property funds, security interests, money, materials, labor,
supplies or services from any governmental entity or unit or any
person, firm, foundation or corporation.
(8) To require, notwithstanding any other provision in this
code to the contrary, all officers and employees of any state
agency, board, commission, or authority to furnish any records or
information which the authority or its staff requests for
carrying out the purposes of this chapter:
Provided, That the
authority shall hold any records or information received as
confidential as the originating agency, board, commission or
authority would be required to hold confidential by state or
federal law.
(9) To charge fees for services rendered by, applicationsmade to, certificates granted or information distributed by, the
authority for public and private entities and individuals, and to
require reimbursement for expenses incurred by the authority for
public and private entities and individuals in rendering
services, receiving applications, granting certificates and
providing information to, all as determined by rule of the
authority. Payments of fee shall be deposited into a special
revolving fund in the state treasury. Any balance, including
accrued interest, in the special revolving fund at the end of any
fiscal year shall not revert to the general revenue fund, but
shall remain in the special revolving fund for use by the
authority in performing its duties under this chapter in ensuing
fiscal years.
(10) To form or participate in the formation of public,
quasi-public or public-private corporations, foundations or other
entities.
(11) To promulgate pursuant to the provisions of chapter
twenty-nine-a of this code such rules as it deems necessary to
implement the provisions of this chapter and prevent the
circumvention and evasion thereof, including rules for all
policies, programs, and services relating to health or health
care services operated, financed, monitored, managed, controlled,
regulated or provided by any state health program.
(12) To obligate and expend funds prior to the service
provided therefor, so as to enable the authority to provide
start-up funds for various programs and projects.
(13) To conduct such hearings and investigations as it deems
necessary for the performance of its duties. The authority shall
announce the time, date and purpose of all hearings in a timely
manner and such hearings shall be open to the public except as
may be necessary to conduct business of an executive nature. Any
hearing may be conducted by the authority or a hearing examiner
appointed for such purpose. The chair of the authority may issue
subpoenas and subpoenas duces tecum, which shall be issued and
served pursuant to the time and enforcement specifications in
section one, article five, chapter twenty-nine-a of this code.
(14) To exercise any and all other powers necessary for the
authority to discharge its duties and otherwise carry out the
purposes of this chapter.
(b) The authority is charged with the responsibility of
initiating and implementing comprehensive health care reform in
West Virginia consistent with the health care reform principles
specified in section three of this article and other provisions
included within this chapter:
Provided, That except as
specifically designated by this article, the authority shall not
be responsible for the day-to-day administration of any state
health program. No person harmed or aggrieved by the action or
inaction of a particular state health program shall have a right
to appeal to the authority to challenge that action or inaction
or to sue the authority for injuries resulting therefrom but
shall appeal to the appropriate circuit court or file suit
against the appropriate state health program. Specificresponsibilities of the authority shall be to set policy
guidelines and priorities for health care reform including, but
not limited to:
(1) Quality assurance in the provision of health care
services, and regulations and licensing regarding health care
services, providers, and payors;
(2) Data collection, analysis, research and planning with
respect to the state's health care system;
(3) Regulation, management, oversight and the development of
rate setting methodologies for public and private health care
purchasing in the state;
(4) The development of rate setting methodologies and
oversight of the health insurance industry in the state;
(5) The promotion of health care networks of preventive,
primary, secondary and tertiary care in the state;
(6) Planning and implementing methods to finance and contain
the costs of the state's health care system, including, but not
limited to, the development of rate setting and health care
financing methodologies;
(7) Being the state's designated liaison with the federal
government to implement at the earliest possible date policies
and programs consistent with appropriate federal reforms;
(8) Overseeing state health programs' compliance with the
state health plan;
(9) Dissemination to the public of information regarding the
health status of West Virginians, the state's health care system,and state and federal reform.
(c) The authority shall be solely responsible for preparing,
amending and/or modifying the state health plan in order to guide
state health programs toward achieving the health care reform
principles defined in section three of this chapter. The state
health plan heretofore developed by the health care planning
commission and approved by the governor shall remain in effect
until amended or modified by majority vote of the authority. All
state health programs and their regulatory activities shall
comply with the provisions of the state health plan as prepared,
amended, and/or modified by the authority:
Provided, That any
proposed amendments or modifications to the state health plan
that contradict any specific provisions of this code and thus
cannot be implemented with executive action shall be submitted to
the Legislature in the form of proposed legislation. The
authority shall promulgate procedural rules for amending and
modification of the state health plan on or before the first day
of September, one thousand nine hundred ninety-four.
§16A-1-8. Specific duties of the authority; deadlines.
(a)
Advisory groups and task forces. -- On or before the
first day of July, one thousand nine hundred ninety-four, the
authority shall establish an advisory group to represent health
care providers interests and concerns before the authority. The
regional health advisory councils now in existence shall continue
to serve as community health advisory committees, under the
direction of the director of consumer affairs. On or before thefirst day of September, one thousand nine hundred ninety-four,
the authority shall appoint a long-term care task force to
develop a comprehensive state long-term care plan by the first
day of September, one thousand nine hundred ninety-five,
consistent with the goals and objectives defined in section
thirteen of this article and the malpractice reform task force
provided for in section fifteen of this article.
(b)
State health programs. -- On or before the first day of
September, one thousand nine hundred ninety-four, the authority
shall determine the state health programs with policies,
programs, services, duties or responsibilities relating to health
or health care that shall be subject to the guidelines contained
within the state health plan. Such programs shall include at a
minimum, the department of health and human resources, the health
care cost review authority, the division of workers'
compensation, the public employees' insurance agency, the
division of insurance, and the division of rehabilitation
services. Each state health program shall ensure that its
policies, programs, services, actions and expenditures are
consistent with the provisions of this chapter, the state health
plan, and other guidelines established by the authority.
(c)
Policy recommendations. -- On or before first day of
December, one thousand nine hundred ninety-four, the authority
shall present a preliminary set of administrative and legislative
recommendations to the governor and Legislature. On or before
the first day of October, one thousand nine hundred ninety-five,the authority shall present a comprehensive set of specific
administrative and legislative recommendations to the governor
and the Legislature reasonably designed to:
(1) Assure that after the first day of January, one thousand
nine hundred ninety-seven, all West Virginians will have access
to appropriate health care services regardless of financial or
health status:
Provided, That this provision shall be construed
to create an entitlement of health care services for any
particular individual at any time;
(2) Increase the availability of primary and preventive care
services and professionals in underserved areas of the state;
(3) Slow or reduce to the general inflation rate the rate of
health care cost increases for all payors;
(4) Improve the health status of the citizens of this state;
(5) Increase the administrative efficiency and quality of
state health programs;
(6) Maximize the opportunities presented by comprehensive
federal health care reform initiatives; and
(7) Assure the quality, integration, and coordination of
health care services.
The recommendations described in this subsection shall be
accompanied by analyses of at least the following issues:
The effect and estimated future value of cost containment
initiatives already implemented in state health programs and
methods to institute further cost containment methods for such
programs;
The advisability of instituting rate setting methodologies
such as diagnostic related groups, resource-based relative value
scales, and global budgets;
The extent to which capitated and other managed health care
systems are available or potentially available in the state and
specifically, whether such systems allows the state to provide
medicaid coverage to the working poor without increasing the
overall costs of the program;
The extent to which state-funded health professions schools
have helped increase access to primary and preventive care
services in underserved areas of the state and recommendations
regarding the same;
The need, if any, for reform of the health insurance
industry and the corresponding regulatory framework in this
state.
(d)
Practice guidelines demonstration project. -- On or
before the first day of January, one thousand nine hundred
ninety-five, the authority shall propose by legislative rule a
set of practice guidelines for obstetrical services. Upon
approval by the legislative rule-making and review committee,
these practice guidelines shall provide the basis for an
affirmative defense to malpractice claims predicted on actions
taken within those guidelines;
(e)
Annual certificate of need capital allocation budget. --
On or before the first day of January, one thousand nine hundred
ninety-five and each year thereafter, the authority shall specifyin the state health plan a maximum annual statewide budget for
capital expenditures requiring certificates of need. Said budget
shall:
(1) Establish classes of certificates of need and the
maximum aggregate amount of certificates that may be issued
within each class each year;
(2) Support the regionalization of high technology and
specialty care and the development of primary care and other
community-based, low-cost services;
(3) Support the establishment and use of integrated health
care networks;
(4) Provide the exceptions in emergency circumstances that
pose a threat to public health; and
(5) Provide for the application of the budget and
certificate of need allocation by the health care cost review
authority pursuant to article two-d, chapter sixteen of this
code.
If necessary, the authority shall declare a moratorium on
approval of certain or all classes of certificates of need for up
to a six month period in order to effectively implement this
subsection. The health care cost review authority shall have no
discretion to approve capital expenditures in excess of its
capital expenditure budget allocation. In no event shall the
annual capital expenditure cap exceed the average of total
capital expenditures subject to certificate of need review for
the proceeding three fiscal years.
(f)
Statewide global budget target. -- On or before the
first day of December, one thousand nine hundred ninety-five and
each year thereafter, the authority shall specify in the state
health plan a projected statewide global budget target for total
annual health related expenditures in the state for the fiscal
year 1996-97, detailing appropriate categories of expenditures
and describing the state health programs involved in
administering or regulating such expenditures. For fiscal year
1997-98 and each year thereafter, each state health program shall
take all steps necessary to ensure that the portion of the
statewide global budget over which it has administrative or
regulatory authority shall not exceed the statewide budget so
specified.
(g)
Self-referral guidelines. -- On or before the first day
of July, one thousand nine hundred ninety-five, the authority
shall establish directives for health care providers regarding
prohibited patient referrals between health care providers and
entities providing health care services to protect the citizens
of West Virginia from unnecessary and costly health care
expenditures.
§16A-1-9. Management of state health programs and facilities.
(a) The following cost containment strategies must be
implemented by state health programs:
(1) Medicaid, PEIA, and workers compensation shall
consolidate certain administrative functions, including, but not
limited to, common claim forms, standardized policies andprocedures, shared hospital bill audit mechanisms, and data
reporting on or before the first day of July, one thousand nine
hundred ninety-four.
(2) Medicaid shall, on or before the first day of July, one
thousand nine hundred ninety-four:
(i) Implement a statewide capitated managed care system for
behavioral health care services that maximizes opportunities for
federal funding for such services without increasing total state
behavioral health expenditures; and
(ii) Submit to the federal government necessary waiver
requests to implement a capitated managed care demonstration
project for families and the elderly.
(3) PEIA shall develop and implement a capitated managed
care option for enrollees by the first day of July, one thousand
nine hundred ninety-five.
(b) The Legislature hereby finds that there is a critical
need for enrollees in state health programs to have adequate
access to primary care services; that there is a severe shortage
of primary care health professionals in underserved areas of the
state; and that there is increasing difficulty in recruiting and
retaining primary care professionals as demand for their services
increases nationwide. The Legislature further finds that there
is substantial need for state health programs to adequately
reimburse health professionals for primary care services provided
their enrollees. Accordingly, on or before the first day of
July, one thousand nine hundred ninety-four, PEIA, medicaid andany other state health programs designated by the authority to
comply with this subsection shall adopt enhanced reimbursement
rates and other appropriate mechanisms specifically designed to
encourage primary care professionals to practice in the state
over the long term so that the enrollees of state programs can
obtain primary care services.
(c) In recognition of the significant costs associated with
the the public management and operation of state health
facilities and the need to make better use of state and federal
funds funding and potentially funding the essential services
provided by those facilities, notwithstanding any other provision
in this code to the contrary, the secretary of the department of
health and human resources shall on or before the first day of
July, one thousand nine hundred ninety-six, close, sell, lease,
or otherwise transfer to the private sector any state health
facility, or otherwise arrange for the private sector
administration or operation of said facility by contract or any
other means:
Provided, That prior to any transfer of patients or
residents from a state health facility occurring as a result of
any such closure, sale, lease, contract or other form of transfer
made pursuant to this subsection, the secretary must have a
detailed plan providing for the appropriate care, placement and
movement of said patients or residents:
Provided, however, That
any person or entity to whom a state health facility is sold,
leased or otherwise transferred pursuant to this subsection shall
be exempt from the provisions of subsection (g), section five,article two-d, chapter sixteen with respect to the addition or
construction of nursing beds within a thirty-mile radius of said
state health facility, not to exceed the number of such beds
filled by residents or patients in said facility immediately
preceding said sale or transfer:
Provided further, That all
assets not sold, leased, or otherwise transferred or conveyed to
the private sector shall be declared and treated as surplus state
property.
§16A-1-10. Executive secretary for health care boards; task
force on health profession licensing boards.
(a) The Legislature hereby finds that the primary purpose
and function of the state's health profession licensing boards is
to protect the public from inappropriate personal health care
services. The Legislature further finds that the currently
fragmented system of staffing health profession licensing boards
is inefficient and fails to adequately protect the public from
inappropriate health care practices in that some boards have no
professional staff to help them conduct their business, have
limited accessibility to the public, respond only to complaints
and fail to actively monitor their licensees. In addition, the
fragmentation of health profession licensing boards impedes the
collection of health professions data essential to the planning
and implementation of health care reform contemplated by this
chapter. The Legislature further finds that in certain instances
the consolidation of the management and staffing of the health
profession licensing boards will create efficiencies that willenable said boards to have more resources and fulfill their
public responsibility to protect and inform the public.
(b) On or before the first day of August, one thousand nine
hundred ninety-four, the authority shall appoint the executive
secretary for health profession licensing boards provided in
section fifteen, article one, chapter thirty of this code, who
shall report to the authority's director of administration. The
first task of the executive secretary shall be to appoint a task
force on health care licensing boards composed of representatives
of health care providers, existing health profession licensing
boards and consumers. The task force, which shall be chaired by
the executive secretary, shall recommend ways to implement the
provisions of this section and otherwise improve the
effectiveness and efficiency of the health profession licensing
boards.
(c) On or before the first day of January, one thousand nine
hundred ninety-five, the task force shall present recommendations
and appropriate legislation to the Legislature and governor that
is designed to:
(1) Define and coordinate language, purpose and public
service orientation of practice acts for the various state health
profession licensing boards;
(2) Require consistent record keeping and reporting for
health profession licensing boards;
(3) Subject to section seventeen, article one, chapter
thirty of this code, require boards, providers, law enforcementagencies and courts to report actual and possible medically
related violations to health profession licensing boards within
specified time limits;
(4) Provide consumer access to specified information from
health profession licensing boards;
(5) Provide health profession licensing boards with broader
disciplinary responsibilities and options;
(6) Provide protection for health profession licensing board
members, providers and consumers who provide information in good
faith;
(7) Provide for improved funding of health profession
licensing boards;
(8) Create a complaint and feed-back system which covers all
health profession licensing boards;
(9) Evaluate classes of unlicensed providers for licensing
and accreditation;
(10) Establish licensing for ambulatory care, urgent care,
nursing care, home health care and free-standing health care;
(11) Merge health profession licensing boards for similar
health care providers;
(12) Require health profession licensing boards to develop
and use assessment processes;
(13) Require continuing education for relicensing; and
(14) Plan for the appropriate consolidation of health
profession licensing board staff.
(d) The authority shall assess each health professionlicensing board an appropriate amount of funds to adequately fund
the work of the task force. On or before the first day of July,
one thousand nine hundred ninety-five, the administration of all
health profession licensing boards shall be consolidated
consistent with the task force's recommendations under the
direction of the executive secretary.
(e) The uniform health professionals' data system previously
established under the commissioner of the bureau of public health
shall be continued under the executive secretary. The data to be
collected and maintained shall include, but not be limited to,
the following information about each health professional: His or
her name; profession; the area of the state where practicing;
educational background; employer's name; and number of years
practicing within the profession. The health care profession
licensing boards, and any successor or successors thereto, shall
collect the data on health professionals under their jurisdiction
on an annual basis and in the format prescribed by the executive
secretary. Each such board shall be required to pay to the
authority an amount, to be determined by the authority, to cover
expenses reasonably incurred by or on behalf of the executive
secretary in establishing and maintaining the uniform health
professionals' data system required by this section. The
executive secretary shall publish or cause to be published
annually and make available upon request, a report setting forth
the data which was collected the previous year, areas of the
state which the collected data indicates have a shortage ofhealth professionals, and projections, based on the collected
data, as to the need for more health professionals in certain
areas.
§
16A-1-11. Certification of health care networks.
(a) It is hereby the intent of the Legislature that the
authority, on behalf of the state, become actively involved in
the development of cooperative and collaborative efforts by local
health care providers to ensure cost effective access to quality
health care services for the citizens of this state. This action
is imperative not only to make the best use of existing health
professionals and facilities, but also to retain those resources
in the future.
(b) On or before the first day of July, one thousand nine
hundred ninety-five, the authority shall develop and implement a
system for certification of health care networks. A health care
network is a locally based organization of health care, education
and support service providers, which promotes a cooperative and
collaborative approach to the delivery of health care services
and provides for the complete range of health care and, in some
cases, social needs of its patients, and which is planned,
established and operated on a community level within the
framework of a state plan. In order to be so designated, a
network must:
(1) Access, costs and quality of health care services for a
geographically-defined population;
(2) Provide or arrange for the delivery of integratedpreventive, primary care and acute care services; and
(3) Provide or arrange for the delivery of other health,
social and transportation services as deemed necessary by the
legally recognized organization.
Health care networks must meet such other criteria as are
set forth by the authority in the state health plan.
§16A-1-12. Antitrust; state action.
(a) The Legislature hereby specifically finds that the
integration of and cooperation and collaboration among health
care providers, including those that would otherwise be in
competition, often provide more benefits than the competition
that would otherwise be provided and, consequently, with the
determinations made by the authority pursuant to this article,
justify exemption from the antitrust provisions of state and
federal law.
(b) It is the intent of this article to require the state,
through the authority, to provide direction, supervision and
control over health care networks certified pursuant to section
eleven of this article to such an extent as to provide immunity
under federal antitrust laws to the health care organizations or
practitioners so certified.
(c) The antitrust provisions set forth in article eighteen,
chapter forty-seven of this code do not apply to discussions
authorized under this article. Any contract, business or
financial arrangement or other activity, practice or arrangement
involving health care providers or other persons that is approvedby the authority under this article does not constitute an
unlawful contract, combination or conspiracy in unreasonable
restraint of trade or commerce. Approval by the authority is an
absolute defense against any action under the state antitrust
laws.
(d) Nothing in this article gives the authority or any
person the right to require a health care provider or other
person to discuss or enter into a health care network or to
preclude a health care provider or other person from attempting
to collaborate or cooperate for the provision of health care
services independent of the certification process defined by the
authority. This article has no effect on any cooperative
agreement made, cooperative action entered into or network formed
by two or more health care providers or other persons who are not
acting under this article.
§16A-1-13. Long-term care.
(a) The authority shall be responsible for comprehensive
long-term care planning and shall develop and submit to the
governor and the Legislature, not later than the first day of
September, one thousand nine hundred ninety-five, a comprehensive
state long-term care plan. The long-term care plan shall set
forth goals and objectives taking into consideration a full range
of long-term care services and activities and policy with respect
to the following:
(1) A system for long-term support based upon an
individual's functional needs and not categorical labels;
(2) Policies, programs and resource allocation
recommendations that reflect a shift away from providing
traditional care in medically oriented facilities toward
providing support in natural environments whenever possible;
(3) The development of an effective system of service
coordination for long-term care consumers that provides for
varying levels of support depending upon the needs of the
individual;
(4) Recommendations for the development, integration and
coordination of services, including, but not limited to, the
following:
(A) Case management;
(B) In-home services;
(C) Care-giver support;
(D) Alternative community living;
(E) Rehabilitation services;
(F) Mental health services;
(G) Transportation services;
(H) Assistive technologies;
(I) Long-term care facilities, in-patient mental health
facilities and rehabilitation facilities;
(J) Education; and
(K) Other services to meet people's basic needs;
(5) Strengthening informal support systems as part of long-
term care; and
(6) Emphasis on consumer participation and direction.
(b) The authority may from time to time engage in research
and demonstration activities for the purpose of designing,
testing and implementing statewide strategies for long-term care
service development in accordance with the long-term care plan.
§16A-1-14. Wellness; community-based health promotion programs.
(a) The Legislature hereby specifically finds that good
health is greatly influenced by social and economic factors and
individual lifestyles and behaviors and that organizational and
institutional changes must be made to support individual change.
(b) The authority shall develop or cause to be developed,
not later than the first day of January, one thousand nine
hundred ninety-five, a plan for educating West Virginians on
proper access and use of the health care system and for
encouraging West Virginians to adopt and maintain healthful
lifestyles. Such plans, among other measures, shall encourage
people to:
(1) Establish a relationship with a primary care provider
before they get sick;
(2) Assure continuity of care by remaining with one primary
care provider unless there is a substantial reason to change
providers;
(3) Use a primary care provider rather than a hospital
emergency room for nonemergency health care problems;
(4) Follow a recommended schedule of preventive care;
(5) Follow the advice and instructions of their health careproviders;
(6) Take an active, informed role in the treatment process;
(7) Learn principles of self-care; and
(8) Complete advance directive documents such as those
provided for in articles thirty and thirty-a, chapter sixteen of
this code.
(c) The authority shall also support and encourage health
promotion and wellness in the workplace by providing educational
and administrative support to entities, including, but not
limited to, any nonprofit corporation organized to promote
wellness among private employers, to promote, coordinate, assist
and disseminate successful wellness initiatives and shall promote
and support the creation and maintenance of organized community-
based health promotion programs throughout the state.
§16A-1-15. Task force on tort and liability system.
Not later than the first day of September, one thousand nine
hundred ninety-four, the authority shall appoint a task force to
study and make recommendations on ways to improve the tort
liability system as it effects the state's health care system.
Such task force shall evaluate and quantify where possible the
extent to which various tort reform proposals, including, but not
limited to, mandatory scheduling conferences within time limits,
reduction in the statutes of limitation and other procedural
reforms, changes in prefiling discovery to include only those
parties directly involved, alternative dispute resolution
mechanisms for health care negligence suits, incentives for earlyresolution through the creation of an accelerated compensation
event system; the manner in which practice guidelines may be used
as standards of care in malpractice cases, a sliding scale for
attorney fees; revision of the collateral source rules,
mechanisms to limit the adverse effects of derivative liability
theories for physicians and other health care providers and
facilities working with midlevel practitioners, and such other
matters the task force may deem appropriate, may have an impact
on the availability, quality and affordability of health care
services in the state. The task force shall present its
recommendations to the governor and the Legislature on or before
the first day of October, one thousand nine hundred ninety-five.
ARTICLE 2. PUBLIC HEALTH SYSTEM.
§16A-2-1. Short title.
This article is the "Public Health System Act of 1994."
§16A-2-2. Legislative findings and purposes.
The health problems of West Virginia and pending federal
reforms demand that health care reform in this state include an
aggressive public health initiative that redefines the mission
and role of public health. Specifically, the state's public
health system must focus on providing core public health
functions and those population-based services and preventive
population-based services identified by the federal centers for
disease control and prevention and the institute of medicine. As
the public health role and mission are redefined and as a
reformed health care delivery system is implemented, manyindividuals currently receiving primary care services from local
health departments will receive such care from other health care
providers as such providers become available to such individuals.
Care must be taken in a redesigned public health system to assure
that individuals will not lose needed services and our public
health system does not suffer because of any change of focus or
method of funding of local health services.
The purpose of this legislation is to promote the
achievement of all the above through the establishment of an
efficient and coordinated public health system in which local
boards of health, regional public health networks, the public
health system advisory council and the bureau of public health
work together to achieve the most effective public health system
possible.
§16A-2-3. Definitions.
(a) "Core public health functions" means the assessment of
community health status and available resources; policy
development resulting in efforts to achieve better health; and
assuring that needed services are available, accessible and of
acceptable quality.
(b) "Population-based services" means services that focus on
the identification of health threats, community health
protection, screening and prevention services, health promotion
programs and services that improve access to care.
(c) "Preventive population-based services" means services
that target the health status of the entire population, asopposed to health care services which target individuals and
which are usually administered after a person becomes ill.
§16A-2-4. Public health system advisory council.
There is hereby created a public health system advisory
council (hereinafter "council"). The council shall be appointed
by the commissioner of the bureau of public health in the
department of health and human resources, who shall also appoint
the council's chair. The members of said council shall reside
throughout the state and represent diverse segments of the
public. The council members shall serve without compensation,
except they may be reimbursed for reasonable expenses incurred in
the performance of their duties. The department of health and
human resources shall, within funds available, provide the
council with such staff support, information and consultants as
the council deems necessary. Meetings of the council shall be
called by the chair.
The council shall advise the health care authority and the
commissioner of the bureau of public health in the department of
health and human resources as to the development of a public
health system and engage in activities to promote that
development. Specifically, the council shall recommend to the
commissioner:
(a) The number and geographic boundaries of regional public
health networks to be established throughout the state;
(b) The appropriate roles and relative authority of the
bureau of health, regional public health networks and localboards of health in this state's public health system;
(c) The means of funding such networks;
(d) The training needs required by those networks, local
health departments and others involved in public health; and
(e) Such other matters as the council deems advisable to
promote the development of a public health system envisioned by
this act.
§16A-2-5. Local health boards.
In addition to duties performed by a local board of health
under articles two and two-a, chapter sixteen of this code, each
local health board shall coordinate its activities with its
regional public health network; conduct community health
assessment and assurance activities; develop local policy
recommendations based on its findings; deliver certain
population-based services; and provide other core public health
functions.
Each local board of health shall appoint a person to serve
as a member of its regional public health network, except a
combined local board of health created under the authority of
section three, article two, chapter sixteen of this code, shall
appoint as many persons as members of its regional public health
network as there are jurisdictions which formed such combined
local boards.
If by the first day of March, one thousand nine hundred
ninety-five, a local board of health has not made its appointment
or appointments to its regional public health network, thedepartment of health and human resources shall make such
appointment or appointments who shall serve until replaced by
appointment by the local board of health.
§16A-2-6. Regional public health networks.
The department of health and human resources, in
consultation with the public health system advisory council,
shall create regional public health networks to facilitate the
development of a model statewide public health system. A
regional public health network shall be a subdivision of the
state and shall execute the public health policies of the
department of health and human resources, so far as applicable to
its region, and shall have such powers as are necessary to
accomplish within its region the public health system purposes of
this act.
The regional health networks shall consist of members
appointed by each local board of health located within the
applicable region in accordance with sections of this article.
The commissioner of the bureau of public health in the department
of health and human resources shall appoint the chairs of
regional public health networks. The regional public health
network chairs shall be appointed for three-year terms, except
that one third of the first set of chairs appointed shall be
appointed for one year and one third of the first set of chairs
shall be appointed for two years. Chairs may be reappointed.
The regional public health networks shall receive such
funding as is made available by the state and other sources andeach such network shall expend such funds toward the development
and maintenance of its regional public health network and for
local health services within its region.
ARTICLE 3. INFORMATION SYSTEM; REQUIREMENTS.
§16A-3-1. Information system.
(a) The authority shall develop an information system that
collects and provides data with which the authority can evaluate
health care reform initiatives and the effectiveness and
efficiency of health care services in the state. The authority
shall be responsible for coordinating data systems, analyzing
studies and developing and disseminating information to policy
makers, health care providers and the public.
(b) The authority may carry out its responsibilities under
this article either directly or indirectly by delegating to
another state agency or by contracting with any public, private
or public-private entity.
§16A-3-2. Collection of data; information to be provided.
(a) The authority shall collect data from health care
providers, health insurers and individuals in the most cost-
effective manner, which does not unduly burden the providers,
insurers or individuals. The authority may require health care
providers and health insurers to collect and provide, subject to
the provision of this article requiring confidentiality, patient
health records and to cooperate in other ways with the data
collection process. Each payor of health care services in the
state shall furnish any information reasonably required by theauthority. Such information shall be provided by electronic
media, tape or diskette if available or as otherwise requested by
the authority.
(b) Each agency of state government required to submit a
report regarding any aspect of health care to the Legislature or
the governor, or both, shall, at the same time, submit a copy of
such report and source data in electronic and hard copy form to
the authority.
(c) The state health care cost review authority shall
provide to the authority all data it receives regarding hospital
discharges, nursing home occupancy rates, ambulatory-surgical
data and similar information. In addition to information
currently received, the health care cost review authority shall
require each hospital to provide it with such other information
as the authority may reasonably request to carry out its duties.
The insurance commissioner of West Virginia shall provide to the
authority any information upon request and shall enforce the
applicable requirements of this section. The university of West
Virginia board of trustees and the board of directors of the
state college system shall provide to the authority all
information on health profession students and residents as the
authority reasonably requests. If such information is not
available, the boards shall take necessary steps to compile such
information.
(d) Each agency of state government, including those
specified in subsection (d) of this section, shall provide theauthority with any data or information requested, including data
that are considered confidential or otherwise protected from
external release. Such data shall be subject to the same state
and federal statutory provisions as are applicable to the agency
from which the data was originally obtained. Data which is
otherwise protected by statute shall not be further transferred
to any entity by the authority without a separate written
agreement with the agency which originally provided the data to
the authority.
(e) All data collected and maintained by any state agency
relating to health care or any aspect of health care delivery in
West Virginia, and any compilation, summary or analysis thereof
or other information in connection therewith, shall be the
property of the authority and shall be collected, maintained and
used by such state agencies only in accordance with the rules,
policies or guidelines established by the authority.
§16A-3-3. Confidentiality.
(a) The authority shall not release data that identifies
individuals by name except as specifically required by this code
or by court order. The authority may release data identifying
individuals by number or similar methods and other data not
generally available to the public, to researchers affiliated with
university research centers or departments who are conducting
research on health outcomes, practice guidelines and medical
practice style and to researchers working under contract with the
authority. The authority may also release such data to any otherperson who the authority determines is appropriate to receive
such information:
Provided, That such persons must agree to
protect the confidentiality of such data according to this
article.
(b) Summary data derived from any of the data collected by
or for the authority may be released in studies produced by the
authority or by any of its contractors, cosponsors and research
affiliates.
(c) The authority shall adopt rules to establish criteria
and procedures to govern access to and the use of data collected
by or for the authority. Records regarding individuals shall not
be subject to release under article one, chapter twenty-nine-b of
this code or under any other freedom of information provisions.
§16A-3-4. National health status indicators.
The authority shall implement or cause to be implemented a
periodic analysis and publication of data necessary to measure
progress toward objectives for at least ten of the priority areas
of the national health objectives and participate or cause the
bureau of public health of the department of health and human
resources to participate in the development and implementation of
a national set of health status indicators appropriate for
federal, state and local health agencies.
§16A-3-5. Study of administrative costs.
The authority shall study costs and requirements incurred by
health insurers, group purchasers, health care providers and, to
the extent possible, individuals that are related to thecollection and submission of information regarding health care to
the state and federal government, insurers and other third
parties. The authority shall implement by the first day of July,
one thousand nine hundred ninety-five, any reforms that may
reduce these costs without compromising the purposes for which
the information is collected.
§16A-3-6. Health care medical records, confidentiality; criminal
penalties.
(a) Any health care provider who has custody of medical
records may reveal specific medical information contained in
those records to the individual on whom the record is kept, to
the individual's agent or representative, or as otherwise
specifically authorized in this code.
(b) Any health care provider who has custody of health care
records may not reveal specific health care information contained
in those records to any person unless authorized by the
individual on whom the record is kept.
(c) Subsection (b) of this section does not apply to a
health care provider who has custody of medical records if the
provider is:
(1) Performing health care services or allied support
services for or on behalf of a patient;
(2) Providing information requested by or to further the
purpose of a medical review committee, accreditation board or
commission or in response to a court order;
(3) Providing information required to conduct the properactivities of the health care provider;
(4) Providing information at the request of a researcher for
medical and health care research under a protocol approved by an
institutional review board or as requested by the authority;
(5) Revealing the contents of health care records under
circumstances where the identity of the patient is not disclosed,
either directly or indirectly, to the recipient of the records;
(6) Providing information requested by another health care
provider of medical care for the sole purpose of treating the
individual on whom the record is kept;
(7) Providing information to a third party payor for billing
purposes only;
(8) Providing information to a nonprofit health service plan
or a blue cross or blue shield plan to coordinate benefit
payments under more than one sickness and accident, dental, or
hospital and medical insurance policy other than an individual
policy; or
(9) Providing information to organ and tissue procurement
personnel in accordance with any applicable laws or rules at the
request of a physician for a patient whose organs and tissue may
be donated for the purpose of evaluating the patient for possible
organ and tissue donation.
(d) The knowing breach of the confidentiality of any health
care records by a health care provider or anyone who obtains
access to personally identifiable health care information shall
be a misdemeanor, punishable by a fine of two thousand dollars.
CHAPTER 18C. STUDENT LOANS; SCHOLARSHIPS AND STATE AID.
ARTICLE 3. HEALTH PROFESSIONALS STUDENT LOAN PROGRAMS.
§18C-3-1. Health education loan program; establishment;
administration; eligibility; penalty for nonperformance of
loan terms.
(a)
Legislative findings.
-- The Legislature finds that
there is a critical need for additional practicing health care
professionals in West Virginia. Therefore, there is hereby
created a rural health education student loan program to be
administered by the senior administrator of the higher education
central office and under the jurisdiction of the vice chancellor
for health sciences. The purpose of this program is to provide
a loan for tuition and fees educational costs to students
enrolled in health education programs at West Virginia
institutions of higher education in this state, whether public or
private, who intend to practice their profession in underserved
areas in the state following completion of their studies or in a
health care specialty in which there is a shortage of health
professionals as determined by the health care authority. The
loans are not to be awarded on the basis of the financial need of
the student, rather the loans are to be awarded based on the need
of the state to retain all levels of health professionals in all
areas of the state and in all specialties and where possible to
complement the rural health initiative established in article
sixteen, chapter eighteen-b of this code.
(b)
Establishment of special account.
-- There is herebyestablished a special revolving fund account under the board of
trustees in the state treasury to be known as the rural health
education student loan fund which shall be used to carry out the
purposes of this section. The fund shall consist of: (1) All
funds on deposit in the medical student health education student
loan fund in the state treasury on the effective date of this
section, or which are due or become due for deposit in the fund
as obligations made under the any previous enactment enactments
or reenactments of this section; (2) thirty-three percent of the
annual collections from the medical education fee established by
section four, article ten, chapter eighteen-b of this code, or
such other percentage as may be established by the board of
trustees by legislative rule subject to approval of the
Legislature pursuant to the provisions of article three-a,
chapter twenty-nine-a of this code: Provided, That funds derived
from the health education fee shall be used only for loans to
qualified health education students at the school where the fee
was collected; (3) appropriations provided by the Legislature;
(4) penalties assessed to individuals for failure to perform
under the terms of a loan contract as set forth under this
section, and repayment of any loans which may be made from funds
in excess of those needed for loans under this section; (5)
amounts provided by medical associations, hospitals or other
medical provider organizations in this state, or by political
subdivisions of the state, under an agreement which requires the
recipient to practice his or her health profession in this stateor in the political subdivision providing the funds for a
predetermined period of time and in such capacity as set forth in
the agreement; and (6) other amounts which may be available from
external sources. Balances remaining in the fund at the end of
the fiscal year shall not expire or revert. All costs associated
with the administration of this section shall be paid from the
health education student loan fund.
(c)
Eligibility and forgiveness requirements for rural
health education student loan.
-- An individual is eligible for
a health education student loan if the individual: (1) Is
enrolled or accepted for enrollment at the West Virginia
University school of medicine, Marshall University school of
medicine, the West Virginia School of Osteopathic Medicine in a
program leading to the degree of medical doctor (M.D.) or doctor
of osteopathy (D.O.) or any other health professional school in
this state approved by the senior administrator:
Provided,
That
the individual has not yet received one of these degrees and is
not in default of any previous student loan; (2) meets the
established academic standards; and (3) signs a contract to
practice his or her health profession in an underserved area of
the state or in a health care specialty in which there is a
shortage:
Provided, however,
That for every year that an
individual serves in an underserved or shortage area, ten the
actual educational costs and fees up to twenty thousand dollars
of the loan granted to the individual will be forgiven.
Loans shall may be awarded by the senior administrator, withthe advice of the board of trustees director of financial aid of
an approved school of medicine or other health profession school
with the approval of the senior administrator and in accordance
with such rules as may be adopted by the board of trustees on a
priority basis from the pool of all applications with the first
priority being a commitment to serve in an underserved area of
the state or in a medical health care specialty in which there is
a shortage of practitioners in the state as determined by the
state division of health at the time the loan is granted health
care authority with the advice of the office of community and
rural health services. A loan from the fund shall be limited to
the cost of education as determined by the applicable health
profession school up to twenty thousand dollars per year,
whichever is less.
At the end of each fiscal year, any individual who has
received a rural health education student loan and who has
completed the education for which the loan was received shall
submit to the board of trustees a notarized, sworn statement of
service on a form provided for that purpose. Upon receipt of
such statement in proper form and verification that the
individual has complied with the terms under which the loan was
granted, the board of trustees shall cancel an outstanding amount
of the loan equal to the average annual amount of the loan
received up to ten twenty thousand dollars of the outstanding
loan for every full twelve consecutive calendar months of such
service.
If an individual, upon completion of the education for which
a loan was received pursuant to the provisions of this section,
fails to perform the service, fails to submit the required
statement of service, or submits a fraudulent statement, in
addition to other penalties, the individual is in breach of
contract resulting in a penalty of three two times the amount of
the outstanding balance of the loan granted. If at the end of one
year the loan is not paid, the board of trustees shall impose an
interest charge of three percent higher than the prime lending
rate.
A loan recipient who subsequently fails to meet the academic
standards necessary for completion of the course of study under
which the loan was granted or who fails to complete the course of
study under which the original loan was granted is liable for
repayment of the loan amount under the terms for the repayment of
loans established by the board of trustees at the time the loan
contract was executed.
(d)
Loans granted under medical student loan program.
-- Any
student granted a medical student loan or rural health education
loan under the provisions of this section prior to the effective
date of the amendment and under any enactment or reenactment of
this section shall continue reenactment of this section at the
second extraordinary session of the Legislature in the year one
thousand nine hundred ninety-one continues to be eligible for
consideration for receipt of such a loan, and/or obligated to
repay such loan, as the case may be, under the prior provisions. Thereafter, the senior administrator may utilize any funds
remaining in the former health education student loan fund or the
medical student loan fund after all loan grants have been
disposed of for the purposes of the medical student rural health
education loan program. An individual is eligible for
continuation of the medical student loan consideration if the
individual demonstrates financial need, meets established
academic standards and is enrolled or accepted for enrollment at
one of the aforementioned schools of medicine in a program
leading to the degree of medical doctor (M.D.) or doctor of
osteopathy (D.O.):
Provided,
That the individual has not yet
received one of these degrees and is not in default of any
previous student loan:
Provided, however,
That the board of
trustees shall give priority for the loans to residents of this
state, as defined by the board of trustees.
At the end of each fiscal year, any individual who has
received a medical student loan under prior enactments of this
section and who has actually rendered services as a medical
doctor or a doctor of osteopathy in this state in a medically
underserved area or in a medical specialty in which there is a
shortage of physicians, as determined by the division of health
at the time the loan was granted, may submit to the board of
trustees a notarized, sworn statement of service on a form
provided for that purpose. Upon receipt of such statement in
proper form and verification of services rendered, the board of
trustees shall cancel five thousand dollars of the outstandingloan or loans for every full twelve consecutive calendar months
of such service and may cancel up to twenty thousand dollars of
the outstanding loan or loans for every full twelve consecutive
calendar months of such service, such increased forgiveness and
the amount of such increase to be determined by and with the
approval of the vice chancellor for health sciences.
(e)
Report by senior administrator.
-- No later than thirty
days following the end of each fiscal ye?ar, the senior
administrator, through the vice chancellor, shall prepare and
submit a report to the board of trustees for inclusion in the
statewide report card required under section six, article two,
chapter eighteen-b of this code to be submitted to the
legislative oversight commission on education accountability
established under section eleven, article three-a, chapter
twenty-nine-a of this code. The report of the senior
administrator shall include at a minimum the following
information: (1) The number of loans awarded; (2) the total
amount of the loans awarded; (3) the amount of any unexpended
moneys in the fund; and (4) the rate of default during the
previous fiscal year on the repayment of previously awarded
loans.
(f)
Promulgation of rules.
-- The secretary of the
department of education and the arts shall promulgate rules
necessary for the operation of this section.
§18C-3-3. Rural health scholars program.
The rural health scholars program is hereby created, whichprogram shall be administered by the senior administrator and
under the jurisdiction of the vice chancellor for health sciences
of the state university system in accordance with such policies
as may be adopted by the board of trustees. Funds for the rural
health scholars program shall be consolidated with the rural
health education loan fund established pursuant to the provisions
of section one of this article.
The program shall recognize outstanding students committed
to practicing in rural areas or primary care specialties; shall
reimburse students for up to two thousand dollars per year for
expenses incurred by the student in working with a rural
practitioner or attending research conferences and seminars
regarding rural health care and primary care; and shall support
such other activities as the vice chancellor and rural health
advisory council considers necessary or appropriate to promote
the recruitment and retention of students and health care
providers in rural areas or primary care specialties.
§18C-3-4. Primary care support trust fund.
(a) There is hereby created in the state treasury a special
fund under the board of trustees to be known as the primary care
support trust fund. Five percent of all annual general revenue
appropriations made to health profession schools in the state
shall be placed in said fund by the board of trustees on an
annual basis.
(b) Eighty percent of said funds are to be distributed to
health profession schools on a formula basis designed by theboard of trustees. In order to receive these funds, a health
profession school must demonstrate to the vice chancellor's
satisfaction, following consultation with the rural health
advisory council, that the school has made substantial and
effective efforts to support and encourage the continued
placement and retention of primary care health professionals in
underserved areas of the state.
(c) Twenty percent of said funds shall be awarded on a
competitive grant basis to health profession schools based on
applicants demonstrating and proposing exemplary efforts to
support and encourage the continued placement and retention of
primary care health professionals in underserved areas of the
state.
CHAPTER 30. PROFESSIONS AND OCCUPATIONS.
ARTICLE 1. GENERAL PROVISIONS.
§30-1-15. Office of executive secretary of the health profession
licensing boards; appointment of executive secretary;
duties.
The office of the executive secretary of the health
profession licensing boards
is hereby created
by chapter one
hundred two, acts of the Legislature, regular session, one
thousand nine hundred seventy-seven, is hereby continued under
the health care authority established by section five, article
one, chapter sixteen-a of this code. The health profession
licensing boards shall include,
but not be limited to, those
boards provided for in articles
two-a four, five, six, seven,seven-a, eight, ten, fourteen, sixteen, seventeen, twenty,
twenty-one, twenty-five and twenty-six of chapter thirty of this
code.
Additional health licensing boards may be added by action
of the health care authority. Notwithstanding any other
provision of this code to the contrary, the office space,
personnel, records and like business affairs of the health
profession licensing boards shall be within the office of the
executive secretary of the health profession licensing boards.
To the extent needed as defined by the executive secretary, the
secretaries of each of the health profession licensing boards
shall coordinate purchasing, record keeping, personnel, use of
reporters and like matters under the executive secretary in order
to achieve the most efficient and economical fulfillment of their
functions. The executive secretary shall be appointed by the
director of health
care authority and shall report to the
director
of administration of the authority. The executive
secretary shall keep the fiscal records and accounts of each of
the boards. The executive secretary shall keep the director
informed as to the needs of each of the boards. The executive
secretary shall coordinate the activities and efforts of the
boards with the
activities of the health resources advisory
council state health plan and other policies of the health care
authority and shall see that the needs for health
manpower care
professionals perceived by the boards are communicated to the
health resources advisory council health care authority. The
executive secretary shall keep any statistics and information onhealth professions, collected by
or for the boards and shall make
such statistics and information available to the
health resources
advisory council health care authority to aid it in carrying out
its responsibilities.
§30-1-17. Liability limitations of professionals reporting
provider negligence, impairment or incompetence to peer
review committees and professional standards review
committees; reporting results of litigation to committees;
procedure for imposing penalties.
(a) Any member of a professional group or organization
covered by this chapter, including, but not limited to, doctors
of medicine, doctors of chiropractic, doctors of veterinary
medicine, osteopathic physicians and surgeons, doctors of
dentistry, pharmacists, attorneys-at-law, real estate brokers,
architects, professional engineers, certified public accountants,
public accountants, registered nurses, or licensed practical
nurses, who, pursuant to any rule promulgated by the applicable
governing board for that profession, or pursuant to the rules,
regulations or by-laws of any peer review organization, reports
or otherwise provides evidence of the negligence, impairment or
incompetence of another member of his or her profession to the
governing board for such profession or to any peer review
organization shall not be liable to any person for making such a
report if such report is made without actual malice and in the
reasonable belief that such report is warranted by the facts
known to him or her at the time.
(b) In the event a claim or cause of action is asserted
against a member of any profession included in this chapter,
whether an individual or an entity, as a result of the filing of
a report by such member pursuant to the provisions of this
chapter, or the rules and regulations of the applicable governing
board for that profession, or pursuant to rules, regulations or
by-laws of any peer review organization, and such claim or cause
of action is subsequently dismissed, settled or adjudicated in
favor of the person or entity making the required report, the
person or persons who initiated the claim or action shall be
liable for all attorneys fees, costs and expenses incurred by the
reporting professional.
(c) Within thirty days of the dismissal, settlement,
adjudication or other termination of any claim or cause of action
asserted against any professional reporting under the provisions
of this chapter, the person or persons filing such claim or cause
of action shall submit to the applicable governing board the
following information:
(1) The names of the parties involved;
(2) The name of the court in which the action was filed, if
applicable;
(3) The bases and nature of the claim or cause of action;
and
(4) The results of such claim or cause of action, including
dismissal, settlement, court or jury verdict or other means of
termination.
(d) The health care authority established by section one,
article two, chapter sixteen-a of this code shall promulgate
legislative rules pursuant to the provisions of chapter twenty-
nine-a of this code, establishing procedures for imposing
sanctions and penalties against any member of such profession who
fails to submit to the board the information required by this
section.
(e) The provisions of this section shall not preclude the
application of any immunity protections which may be set forth
under any article in this chapter.
NOTE: The purpose of the West Virginia Health Care Access
and Reform Act of 1994
, is to take the first steps toward a
comprehensive reform of the health care system in West Virginia.
The Act establishes the West Virginia Health Care Authority to
carry out the Act; requires the Authority to identify state
health programs with policies, programs or responsibilities
relating to health or health care and requires such programs to
abide by the state health plan; requires the Authority to update
the state health plan; requires the Authority to undertake
specific actions and studies; requires the state agencies to
undertake cost containment strategies, to establish reimbursement
mechanisms to assist primary care providers in underserved areas,
and to transfer state health facilities to the private sector;
requires studies of long term-care and wellness issues; requires
the authority to establish system for certifying health care
networks and provides for anti-trust exemption for providers
participating in such networks; requires the Authority to develop
an information system from which evaluations can be made and on
which decisions can be based and provides for confidentiality of
data; places the executive secretary of health care boards under
the Authority as eventual exclusive staff support to health
profession licensing boards; establishes a rural health
professions loan fund, a rural health scholars program, and a
funding mechanism to encourage health profession schools to
support rural primary care services; provides limitations on
liability for persons reporting provider negligence.
Strike-throughs indicate language that would be stricken
from the present law, and underscoring indicates new languagethat would be added.
Sections three and four, article three, chapter eighteen-c;
chapter sixteen-a; and section seventeen, article one, chapter
thirty are new; therefore, underscoring and strike-throughs have
been omitted.