Source: http://www.wvlegislature.gov/bill_status/bills_text.cfm?billdoc=SB414%20SUB1.htm&yr=2009&sesstype=RS&i=414
Timestamp: 2018-02-19 15:50:38
Document Index: 499846717

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SB414 SUB1
(By Senators Prezioso, Foster, Jenkins, Stollings, Caruth, Laird, Unger, Minard and Kessler)
A BILL to repeal §5-16-7b of the Code of West Virginia, 1931, as amended; to repeal §5-16C-1, §5-16C-2, §5-16C-3, §5-16C-4, §5-16C-5, §5-16C-6, §5-16C-7, §5-16C-8, §5-16C-9 and §5-16C-10 of said code; to repeal §5A-3-1a of said code; to repeal §5A-3C-1, §5A-3C-2, §5A-3C-3, §5A-3C-4, §5A-3C-5, §5A-3C-6, §5A-3C-7, §5A-3C-8, §5A-3C-9, §5A-3C-10, §5A-3C-11, §5A-3C-12, §5A-3C-13, §5A-3C-14, §5A-3C-15, §5A-3C-16 and §5A-3C-17 of said code; to amend and reenact §5F-2-5 of said code; to amend and reenact §16-2J-2 of said code; to amend said code by adding thereto a new article, designated §16-2L-1, §16-2L-2, §16-2L-3, §16-2L-4 and §16-2L-5; to amend and reenact §16-29H-1, §16-29H-2, §16-29H-3, §16-29H-4 and §16-29H-5 of said code; and to amend said code by adding thereto sixteen new sections, designated §16-29H-6, §16-29H-7, §16-29H-8, §16- 29H-9, §16-29H-10, §16-29H-11, §16-29H-12, §16-29H-13, §16- 29H-14, §16-29H-15, §16-29H-16, §16-29H-17, §16-29H-18, §16-29H-19, §16-29H-20 and §16-29H-21, all relating generally to the creation of the Governor's Office of Health Enhancement and Lifestyle Planning; setting forth legislative findings; setting forth the powers and duties of the office; transferring the powers and duties of the Pharmaceutical Cost Management Council to the office; creating the position of director; setting forth the qualifications of the director; setting forth the powers and duties of the director; providing for staff; requiring the development of a five-year strategic plan; providing for legislative rule-making authority; providing for coordination with various state agencies, departments, boards, bureaus and commissions; requiring reporting to the Governor and the Legislature; establishing pilot projects for patient-centered medical homes; setting forth legislative findings; defining terms; evaluating existing medical home pilot programs; establishing criteria for pilot projects for patient-centered medical homes; defining four types of pilot projects; setting forth evaluation criteria; and granting rule-making authority.
(7) Formulate comprehensive budgets for consideration by the Governor, and transfer within the department funds appropriated to the various agencies of the department which are not expended due to cost savings resulting from the implementation of the provisions of this chapter: Provided, That no more than twenty-five percent of the funds appropriated to any one agency or board may be transferred to other agencies or boards within the department: Provided, however, That no funds may be transferred from a special revenue account, dedicated account, capital expenditure account or any other account or funds specifically exempted by the Legislature from transfer, except that the use of appropriations from the State Road Fund transferred to the office of the Secretary of the Department of Transportation is not a use other than the purpose for which the funds were dedicated and is permitted: Provided further, That if the Legislature by subsequent enactment consolidates agencies, boards or functions, the appropriate secretary may transfer the funds formerly appropriated to the agency, board or function in order to implement consolidation. The authority to transfer funds under this section shall expire on the thirtieth day of June, two thousand five; June 30, 2010;
(8) Enter into contracts or agreements requiring the expenditure of public funds, and authorize the expenditure or obligation of public funds as authorized by law: Provided, That the powers granted to the secretary to enter into contracts or agreements and to make expenditures or obligations of public funds under this provision shall not exceed or be interpreted as authority to exceed the powers granted by the Legislature to the various commissioners, directors or board members of the various departments, agencies or boards that comprise and are incorporated into each secretary's department under this chapter;
(e) Notwithstanding any other provision of this code to the contrary, the secretary of each department with authority over programs which have an impact on the delivery of health care services in the state or are payors for health care services or, are payors for prescription drugs, including, but not limited to, the Public Employees Insurance Agency, the Department of Health and Human Resources, the Bureau for Senior Services, the Children's Health Insurance Program, the Health Care Authority, the Office of the Insurance Commissioner, the Division of Corrections, the Division of Juvenile Services, the Regional Jail and Correctional Facility Authority, the Workers' Compensation Fund, state colleges and universities, public hospitals, state or local institutions including nursing homes and veterans' homes, the Division of Rehabilitation, public health departments, the Bureau for Medical Services and other programs, which have an impact on the delivery of health care services, or are payors for health care services or that are payors for prescription drugs, in West Virginia shall cooperate with the Office of the Pharmaceutical Advocate Governor's Office of Health Enhancement and Lifestyle Planning established pursuant to section four, article sixteen-d, chapter five article twenty-nine-h, chapter sixteen of this code for the purpose of purchasing prescription drugs improving the health care delivery services in West Virginia for any program over which they have authority : Provided, That no action of Governor's Office of Health Enhancement and Lifestyle Planning shall encumber greater than five percent of the state share of the annual funds appropriated to any one agency or board without prior approval of the secretary with authority over that office.
(2) "Family" means a subscriber and his or her dependents;(3) "Medical home" means a team approach to providing health care and care management. Whether involving a primary care provider, specialist or sub-specialist, care management includes the development of a plan of care, the determination of the outcomes desired, facilitation and navigation of the health care system, provision of follow-up and support for achieving the identified outcomes. The medical home maintains a centralized, comprehensive record of all health related services to provide continuity of care;
(6) "Provider" has the same meaning as "ambulatory health care facility" set forth in subsection (b), section two, article two-d of this chapter or "private office practice" as set forth in subdivision (1), subsection (a)(1), section four of said article;
(1) There is a need in the state to transform the health care services delivery model toward primary prevention and more proactive care management through the development of patient centered medical homes;
(2) The concept of a patient-centered medical home would promote a partnership between the individual patient, the patients' various health care providers, the patients' family and, if necessary, the community. It integrates the patient as an active participant in their own health and well being;
(3) The patient-centered medical home provides care through a multidisciplinary health team consisting of physicians, nurse practitioners, nurses, physicians assistants, behavioral health providers, pharmacists, social workers, physical therapists, dental and eye care providers and dieticians to meet the health care needs of a patient in all aspects of preventative, acute, chronic, and end-of-life care using evidence based medicine and technology;
The patient-centered medical home is a health care setting that facilitates partnerships between individual patients and their personal physicians and, when appropriate, the patients' families and communities. A patient-centered medical home integrates patients as active participants in their own health and well being. Patients are cared for by a physician or physician practice that leads a multidisciplinary health team, which may include but is not limited to nurse practitioners, nurses, physician's assistants, behavioral health providers, pharmacists, social workers, physical therapists, dental and eye care providers and dieticians to meet the needs of the patient in all aspects of preventive, acute, chronic care and end-of-life care using evidence based medicine and technology.
(a) The Governor's Office of Health Enhancement and Lifestyle Planning, as set forth in article twenty-nine-h of this chapter, shall consult with the Bureau for Medical Services and the Public Employee Insurance Agency on current medical home pilot projects which they are operating for their membership population. The director shall evaluate these programs in consultation with the Commissioner of the Bureau for Medical Services and the Director of the Public Employees Insurance Agency for a means to expand these beyond the populations currently being served by these pilots. Once data is available on these pilots that can be reviewed for planning purposes, the director shall utilize this as a means to develop and implement additional patient-centered medical home pilot programs beyond the limited populations served by the Bureau for Medical Services and the Public Employee Insurance Agency. The director shall develop four varying types of patient-centered medical home pilots based upon experience gained from the projects currently in operation at the Bureau for Medical Services and the Public Employees Insurance Agency. These patient centered medical homes shall be based upon the individual practices of physicians. (b) The four types of pilot programs shall be:
(1) "Advertising or marketing" means to make publically and generally known information, paid for by sponsors through various print or broadcast media or persons, intended to persuade consumers to purchase products, services or ideas related to pharmaceuticals .
(6) "Health care delivery services" means any state provided service aimed at prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical and allied health professions. For the purposes of this article, health care delivery services includes the payment for such services by a state entity.
§16-29H-3. Creation of the Governor's Office of Health Enhancement and Lifestyle Planning; duties.
(b) All state agencies that have responsibility for the development, improvement and implementation of any aspect of West Virginia's health care system, including, but not limited to, the Public Employees Insurance Agency, the Bureau for Senior Services, the Children's Health Insurance Program, the Health Care Authority, the Insurance Commission, the Department of Health and Human Resources, state colleges and universities, public hospitals, state or local institutions such as nursing homes, veteran's homes, the Division of Rehabilitation and public health departments, shall cooperate with the Governor's Office of Health Enhancement and Lifestyle Planning established for the purpose of coordinating the health care delivery system in West Virginia for any program over which they have authority: Provided, That no action of Governor's Office of Health Enhancement and Lifestyle Planning shall encumber greater than five percent of the state share of the annual funds appropriated to any one agency or board without prior approval of the secretary with authority over that office.
(a) The office is under the supervision of the director. The director is the executive and administrative head of the office and shall be appointed by the Governor with advice and consent of the Senate. The director shall be qualified by training and experience to direct the operations of the Governor's Office of Health Enhancement and Lifestyle, and serves at the will and pleasure of the Governor. The duties of the director include, but are not limited to, the management and administration of the Governor's Office of Health Enhancement and Lifestyle.
(7) Develop and implement other programs, projects and initiatives to achieve the purposes of this article, including initiating, evaluating and promoting other strategies that result in greater access to health care, assure greater quality of care and result in reduced costs for health care delivery services to the citizens of West Virginia, and
(b) The advisory council created pursuant to section ten of this article is responsible for reviewing any proposed contract authorized by this article before it is executed by the director. If the advisory council determines that the proposed contract meets the requirements of this article and would assist in effectively managing the costs for the programs involved and would not result in jeopardizing state funds or funds due the state, it shall recommend to the director to execute the contract.
The director may negotiate and execute contracts for the purpose of managing rising health care and drug costs for this state and all parties which have executed health care delivery service or prescription drug purchasing agreements with the state or any state agency, including, but not limited to, the Department of Health and Human Resources, the Public Employees Insurance Agency, the Children's Health Insurance Program, the Health Care Authority, the Office of the Insurance Commissioner, the Division of Corrections, the Division of Juvenile Services, the Regional Jail and Correctional Facility Authority, state colleges and universities, state medical schools and the school of osteopathy, public hospitals, state or local institutions such as nursing homes, veterans' homes, the West Virginia State Police, the Division of Rehabilitation, public health departments and the Bureau of Medical Services or other programs which are providers of services that impact health care delivery in West Virginia.
§16-29H-9. Authorization to amend existing contracts. The director may renegotiate and amend contracts to which the state or any state agency, including, but not limited to, the Department of Health and Human Resources, the Public Employees Insurance Agency, the Children's Health Insurance Program, the Health Care Authority, the Office of the Insurance Commissioner, the Division of Corrections, the Division of Juvenile Services, the Regional Jail and Correctional Facility Authority, state colleges and universities, state medical schools and the school of osteopathy, public hospitals, state or local institutions such as nursing homes, veterans' homes, the West Virginia State Police, the Division of Rehabilitation, public health departments and the Bureau of Medical Services, or other programs which have an impact on health care delivery services in West Virginia is a party for the purpose of managing rising health care costs. In renegotiating existing contracts, the director shall include the secretary, or his or her designee, of the department which is the subject of the contract in all negotiations.
(b) If the director participates in any cooperative purchasing agreement, alliance, or consortium which is comprised of at least five million covered lives, the cooperative purchasing agreement, alliance or consortium may employ either the federal supply schedule or an agreed-upon pricing schedule that, in the judgment of the advocate and the other participating entities, will maximize savings to the broadest percentage of the population of this state: Provided, That any pharmaceutical manufacturer that deals with such cooperative purchasing agreements, alliances, or consortia may request a waiver from such pricing schedule in West Virginia for a particular drug that should be granted if the advocate finds that the development, production, distribution costs, other reasonable costs and reasonable profits excluding marketing, advertising and promotional costs not essential to bringing the product to market are more than the schedule price of the pharmaceutical or in those cases in which the pharmaceutical in question has a sole source . The director shall determine fees to be paid by the applicant at the time of the waiver application and proof required to be submitted at the time of the waiver request to support the validity of the request.
(d) The advisory council is self-sustaining and independent, however, it, its members, the director and employees of the Governor's Office of Health Enhancement and Lifestyle Planning are subject to article nine-a of chapter six, chapter six-b, chapter twenty-nine-a and chapter twenty-nine-b of this code.
(a) The advisory council is comprised of the following governmental officials: The Secretary of the Department of Health and Human Resources, or his or her designee, the Director of the Public Employees Insurance Agency, or his or her designee, the Commissioner of the Office of the Insurance Commissioner, or his or her designee, the Chair of the West Virginia Health Care Authority, or his or her designee. The council shall also consist of the following public members: one public member shall represent an organization of senior citizens with at least ten thousand members within the state, one public member shall represent the interest of family practice physicians or primary care physician, one public member shall represent the West Virginia Chamber of Commerce, one public member shall represent the largest education employee organization in the state, one public member shall represent the largest labor organization in the state, one public member shall represent West Virginia Hospital Association, one public member shall represent the West Virginia Medical Association and two ex- officio nonvoting members shall be the Speaker of the House, or his or her designee, and the President of the Senate, or his or her designee.
(b) Public members shall be appointed by the Governor with advice and consent of the Senate. Each public member shall serve for a term of four years. Of the public members of the advisory council first appointed, one shall be appointed for a term ending June 30, 2010, and two each for terms of three and four years. Each public member serves until his or her successor is appointed and has qualified. The Director of the Governor's Office of Health Enhancement and Lifestyle Planning shall serve as chairperson of the advisory council.
(2) All marketing items of a value less than one hundred dollars;
(a) For purpose of implementing this article, the state is represented by the director and he or she has authority to negotiate health care delivery service costs and pharmaceutical prices to be paid by program participants. These negotiated prices shall be available to all programs. (b) The Department of Health and Human Resources, the Public Employees Insurance Agency, the Children's Health Insurance Program, the Health Care Authority, the Office of the Insurance Commissioner, the Division of Corrections, the Division of Juvenile Services, the Regional Jail and Correctional Facility Authority, state colleges and universities, state medical schhols and the school of osteopathy, public hospitals, state or local institutions such as nursing homes, veterans' homes, the West Virginia State Police, the Division of Rehabilitation, public health departments and the Bureau of Medical Services or other programs which are offer health care delivery services or are payors for prescription drugs shall have the authority to participate in any program developed by the Governor's Office of Health Enhancement and Lifestyle Planning.
To implement any section of this article, the Office of the Pharmaceutical Director, in consultation with the advisory council, shall propose rules for legislative approval in accordance with article three, chapter twenty-nine-a of this code. This authority shall include emergency rule-making authority pursuant to the provisions of section fifteen, article three, chapter twenty-nine-a of this code. These rules may include, but are not limited to:
(1) Development and implementation of patient centered medical homes pilot projects. This rules shall include a means to evaluate these for expansion.
The director shall consult with all the colleges and universities in the state, both public and private, with the state's three medical schools and with community and technical colleges. The purpose of this collaboration would be:
(1) The development of curricula focused on a chronic care model to reflect the multidisciplinary team approach to the delivery of health care services in West Virginia as contemplated by the development of a patient centered medical home as that term is defined in section two, article two-j of this chapter; and
NOTE: The purpose of this bill is establish pilot projects to operate various types of patient centered medical homes throughout the state. This bill was recommended for passage during the 2009 Regular Session by Select Committee D on Health.
§16-2L is new; therefore, strike-throughs and underscoring have been omitted; §16-29H-6 through 22 are new; therefore, strike- throughs and underscoring have been omitted.
Articles §16-29H-1 through 5 has been substantially rewritten; therefore, strike-throughs and underscoring have been omitted.