ENGROSSED
COMMITTEE SUBSTITUTE
FOR
Senate Bill No. 10
(By Senators Chafin and Kessler)
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[Originating in the Committee on Health and Human Resources;
reported March 28, 2001.]
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A BILL to amend and reenact sections one and four, article
four-b, chapter nine of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, all relating
to defining registered nurse first assistant under medicaid;
defining perioperative nursing; providing for medicaid
reimbursement of certain services rendered by a registered
nurse first assistant; and establishing comparative fees for
services provided by a registered nurse first assistant.
Be it enacted by the Legislature of West Virginia:
That sections one and four, article four-b, chapter nine of the code of West Virginia, one thousand nine hundred thirty-one,
as amended, be amended and reenacted, all to read as follows:
ARTICLE 4B. PHYSICIAN/MEDICAL PRACTITIONER PROVIDER MEDICAID
ACT.
§9-4B-1. Definitions.
The following words, when used in this article, have meanings
ascribed to them in this section, except in those instances where
the context clearly indicates a different meaning:
(a) "Board" means the physician/medical practitioner provider
medicaid enhancement board created to develop, review and
recommend the physician/medical practitioner provider fee
schedule;
(b) "Physician provider" means an allopathic or osteopathic
physician, rendering services within this state and receiving
reimbursement, directly as an individual provider or indirectly
as an employee or agent of a medical clinic, partnership or other
business entity;
(c) "Nurse practitioner" means a registered nurse qualified
by virtue of his or her education and credentials and approved by
the West Virginia board of examiners for registered professional
nurses to practice as an advanced practice nurse independently or
in a collaborative relationship with a physician;
(d) "Nurse-midwife" means a qualified professional nurse
registered with the West Virginia board of examiners for
registered professional nurses who by virtue of additional
training is specifically qualified to practice nurse-midwifery
according to the statement of standards for the practice of
nurse-midwifery as set forth by the American college of nurse-
midwives;
(e) "Physician assistant" means an assistant to a physician
who is a graduate of an approved program of instruction in
primary health care or surgery, has attained a baccalaureate or
master's degree, has passed the national certification
examination and is qualified to perform direct patient care
services under the supervision of a physician;
(f) "Registered nurse first assistant" means one who:
(1) Holds a current active registered nurse licensure;
(2) Is certified in perioperative nursing; and
(3) Has successfully completed and holds a degree or
certificate from a recognized program which consists of:
(A) The association of operating room nurses, inc., care
curriculum for the registered nurse first assistant; and
(B) One year of post-basic nursing study, which shall include
at least forty-five hours of didactic instruction and one hundred twenty hours of clinical internship or its equivalent of two
college semesters;
A registered nurse who was certified by the certification
board of perioperative nursing before one thousand nineteen
hundred ninety-seven is not required to fulfill the requirements
of subdivision (3) of this subsection;
(g) "Perioperative nursing" means a practice of nursing in
which the nurse provides preoperative, intraoperative and post-
operative nursing care to surgical patients;
(f) (h) "Secretary" means the secretary of the department of
health and human resources; and
(g) (i) "Single state agency" means the single state agency
for medicaid in this state.
§9-4B-4. Powers and duties.
(a) The board shall:
(1) Develop and recommend a reasonable physician/medical
practitioner provider 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 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.
(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:
Provided, That the single state agency shall provide reimbursement for the services
of a registered nurse first assistant which reimbursement shall
be no less than thirteen and six tenths of one percent of the
rate for a surgeon physician. 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.
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