Senate Bill No. 453
(By Senators Prezioso, Barnes, Dempsey, Unger, Hunter and
Kessler)
____________
[Introduced February 1, 2006; referred to the Committee
on Health and Human Resources; and then to the Committee on
Finance.]
____________
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 through 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.