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Introduced Version Senate Bill 18 History

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Key: Green = existing Code. Red = new code to be enacted
Senate Bill No. 18

(By Senators Prezioso, Minard, Stollings, Hunter, Kessler, Sprouse and McCabe)

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[Introduced January 10, 2007; referred to the Committee on Health and Human Resources; and then to the Committee on Finance.]

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A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §5-16-7f; and to amend said code by adding thereto a new section, designated §9-5-20, all relating to requiring coverage from the Public Employees Insurance Agency and Medicaid for testing for chronic kidney disease; public education of providers on management of chronic kidney disease; and defining diagnostic criteria for chronic kidney disease.

Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new section, designated §5-16-7f; and that said code be amended by adding thereto a new section, designated §9-5-20, all to read as follows:
CHAPTER 5. GENERAL POWERS AND AUTHORITY OF THE GOVERNOR,

SECRETARY OF STATE AND ATTORNEY GENERAL; BOARD

OF PUBLIC WORKS; MISCELLANEOUS AGENCIES, COMMISSIONS,

OFFICES, PROGRAMS, ETC.

ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7f. Required coverage for chronic kidney disease; evaluation and classification.

(a) The plan shall provide a participant or beneficiary who has a diagnosis of diabetes or hypertension or, who has a family history of kidney disease, with coverage for an evaluation for chronic kidney disease through routine clinical laboratory assessments of kidney function.
(b) The diagnostic criteria used to define chronic kidney disease should be those generally recognized through clinical practice guidelines which identify chronic kidney disease or its complications based on the presence of kidney damage and level of kidney function.
(c) The plan may not:
(1) Deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage under the terms of the plan, solely for the purpose of avoiding the requirements of this section; and
(2) Penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide incentives (monetary or otherwise) to an attending provider, to induce such provider to provide care to an individual participant or beneficiary in a manner inconsistent with this section.
(d) Nothing in this section shall be construed to prevent a health benefit plan policy or a health insurer offering health insurance coverage from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.
(e) The provisions of this section shall be included under any policy, contract or plan delivered after the first day of July, two thousand six.
CHAPTER 9. HUMAN SERVICES.

ARTICLE 5. MISCELLANEOUS PROVISIONS.
§9-5-20. Medicaid program; chronic kidney disease; evaluation and classification.

(a) Any enrollee in Medicaid who is eligible for services and who has a diagnosis of diabetes or hypertension or, who has a family history of kidney disease, shall receive coverage for an evaluation for chronic kidney disease through routine clinical laboratory assessments of kidney function.
(b) Any enrollee in Medicaid who is eligible for services and who has been diagnosed with diabetes or hypertension or who has a family history of kidney disease, and who has received a diagnosis of kidney disease shall be classified as a chronic kidney patient.
(c) The diagnostic criteria used to define chronic kidney disease should be those generally recognized through clinical practice guidelines which identify chronic kidney disease or its complications based on the presence of kidney damage and level of kidney function.
(d) Medicaid providers shall be educated by the Bureau for Public Health in an effort to increase the rate of evaluation and treatment for chronic kidney disease. Providers should be made aware of:
(1) Managing risk factors, which prolong kidney function or delay progression to kidney replacement therapy;
(2) Managing risk factors for bone disease and cardiovascular disease associated with chronic kidney disease;
(3) Improving nutritional status of chronic kidney disease patients; and
(4) Correcting anemia associated with chronic kidney disease.



NOTE: The purpose of this bill is to require the Public Employees Insurance Agency and Medicaid to cover testing for chronic kidney disease and to provide some outreach by the Bureau for Public Health to providers regarding chronic kidney disease.

These sections are new; therefore, strike-throughs and underscoring have been omitted.

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