Source: https://www.richmondsunlight.com/bill/2013/sb1186/fulltext/
Timestamp: 2020-07-14 16:47:31
Document Index: 591486188

Matched Legal Cases: ['§ 32', '§ 32', '§ 32', '§ 32', '§ 32', '§ 32']

SB1186H1
SB1186S1
SENATE BILL NO. 1186 AMENDMENT IN THE NATURE OF A SUBSTITUTE (Proposed by the House Committee on Health, Welfare and Institutions on February 14, 2013) (Patron Prior to Substitute--Senator Vogel) A BILL to amend and reenact § 32.1-320 of the Code of Virginia, relating to medical assistance services; duties of Attorney General.
1. That § 32.1-320 of the Code of Virginia is amended and reenacted as follows:
2. Issue subpoenas, propound interrogatories, compel the attendance of witnesses, administer oaths, certify to official acts, take depositions within and without the Commonwealth as now provided by law, and compel the production of pertinent books, payrolls, accounts, papers, records, documents and testimony relevant to such investigation. If a person in attendance before the Attorney General or his authorized representative refuses, without reasonable cause, to be examined or to answer a legal and pertinent question, or to produce a book or paper or other evidence when ordered to do so by the Attorney General or his authorized representative, the Attorney General or his authorized representative may apply to the judge of the circuit court of the jurisdiction where such person is in attendance, upon affidavit, for an order returnable in not less than two nor more than five days, directing such person to show cause why he should not produce such records. Upon the hearing of such order, if the court shall determine that such person, without reasonable cause, has refused to be examined or to answer a legal or pertinent question, or to produce a book or paper which he was ordered to bring or produce, he may forthwith assess all costs and reasonable attorney's attorney fees against such person. If the motion for an order is granted and the person thereafter fails to comply with the order, the court may make such orders as are provided for in the Rules of the Supreme Court of Virginia. Subpoenas shall be served and witness fees and mileage paid as allowed in civil cases in the circuit courts of this Commonwealth. Subpoenas issued under this section are expressly excluded and excepted from the provisions of subsection H of § 32.1-127.1:03. All records, information, reports, documents, memoranda, and communications created or developed during the course of a civil investigation under this section or pursuant to § 32.1-312 shall be considered sensitive and confidential and may be considered attorney work product or privileged investigative files.
SENATE BILL NO. 1186 AMENDMENT IN THE NATURE OF A SUBSTITUTE (Proposed by the Senate Committee for Courts of Justice on January 28, 2013) (Patron Prior to Substitute--Senator Vogel) A BILL to amend and reenact §§ 32.1-320 and 32.1-325 of the Code of Virginia, relating to medical assistance services; duties of Attorney General; allowable charges.
1. That §§ 32.1-320 and 32.1-325 of the Code of Virginia are amended and reenacted as follows:
K. The Department of Medical Assistance Services shall require that the actual charge to the program for fee-for-service providers of medical services, equipment, and materials, for which reimbursement is provided under the plan for services billed using Healthcare Common Procedure Coding System (HCPCS) codes or Current Procedural Terminology (CPT) codes and paid under the state agency fee schedule, shall not exceed the lowest price paid to the provider, directly or indirectly, by an individual or entity including, but not limited to, third-party payors, referring providers, cash-paying customers, and managed care providers, for the same or similar service, including all relevant discounts and rebates.
The following shall be exempt from such requirement, provided that (i) in the event that any federal regulation, fee schedule, or other applicable federal requirement indicates the price should be lower than the actual charge as described above, the Department shall apply the lower price, and (ii) nothing in this section may affect any federal upper limit or other reimbursement limits imposed by applicable federal law:
1. Direct medical services provided in person by doctors, nurses, physician's assistants, nurse practitioners, dentists, dental assistants, optometrists, opticians, chiropractors, podiatrists, mental health providers, substance abuse service providers, home and community based care providers, hospice providers, renal units, clinics, early intervention providers, and targeted case managers;
2. Emergency medical services;
3. Any medical services, equipment, and materials reimbursed based on a fee schedule determined through a competitive bidding process;
4. Services where Medicaid is not the primary payor; and
5. Any Medicaid participating provider who is reimbursed using a prospective payment system or cost-based reimbursement mechanism administered by the Department.
SENATE BILL NO. 1186 Offered January 9, 2013 Prefiled January 9, 2013 A BILL to amend and reenact 32.1-320 and 32.1-325 of the Code of Virginia, relating to medical assistance services; duties of Attorney General; allowable charges.
1. That 32.1-320 and 32.1-325 of the Code of Virginia are amended and reenacted as follows:
32.1-320. Duties of Attorney General; medical services providers audit and investigation unit.
1. Conduct audits and investigations of providers of medical and other services furnished under medical assistance. Such investigations shall include investigation of complaints alleging abuse or neglect of persons in the care or custody of others who receive payments for providing health care services under the state plan for medical assistance, regardless of whether the patient who is the subject of the complaint is a recipient of medical assistance. The relevant board within the Department of Health Professions shall serve in an advisory capacity to the Attorney General in the conduct of audits or investigations of health care providers licensed by the respective regulatory boards. In the conduct of such audits or investigations, the Attorney General may examine (i) those records or portions thereof, including patient records, for which services were rendered by a health care provider and reimbursed by the Department of Medical Assistance Services under the Plan for Medical Assistance, and (ii) in cases involving a complaint alleging abuse or neglect of a person in the care or custody of others who receive payments for medical assistance, those records or portions thereof, including patient records, that are relevant to the investigation of the complaint, notwithstanding the provisions of Chapter 38 ( 2.2-3800 et seq.) of Title 2.2 or of any other statute which may make or purport to make such records privileged or confidential. No original patient records shall be removed from the premises of the health care provider, except in accordance with Rule 4:9 of the Rules of the Supreme Court of Virginia. The disclosure of any records or information by the Attorney General is prohibited, unless such disclosure is directly connected to the official purpose for which the records or information was obtained. The disclosure of patient information as required under this section shall not subject any physician or other health services provider to any liability for breach of any confidential relationship between the provider and the patient, but no evidence resulting from such disclosure may be used in any civil, administrative or criminal proceeding against the patient unless a waiver of the applicable evidentiary privilege is obtained. The Attorney General shall cause all copies of patient medical records in his possession or that of his designee to be destroyed upon completion of the audit, investigation or proceedings, including appeals;
2. Issue subpoenas, propound interrogatories, compel the attendance of witnesses, compel the production of fingerprints, photographs, and handwriting exemplars by witnesses, administer oaths, certify to official acts, take depositions within and without the Commonwealth as now provided by law, and compel the production of pertinent books, payrolls, accounts, papers, records, documents and testimony relevant to such investigation. If a person in attendance before the Attorney General or his authorized representative refuses, without reasonable cause, to be examined or to answer a legal and pertinent question, or to produce a book or paper or other evidence outlined in this subsection when ordered to do so by the Attorney General or his authorized representative, the Attorney General or his authorized representative may apply to the judge of the circuit court of the jurisdiction where such person is in attendance, upon affidavit, for an order returnable in not less than two nor more than five days, directing such person to show cause why he should not produce such records be examined or should not answer a legal and pertinent question or should not produce a book or paper or other evidence outlined in this subsection. Upon the hearing of such order, if the court shall determine that such person, without reasonable cause, has refused to be examined or to answer a legal or pertinent question, or to produce a book or paper or other evidence outlined in this subsection which he was ordered to bring or produce, he may forthwith assess all costs and reasonable attorney's attorney fees against such person. If the motion for an order is granted and the person thereafter fails to comply with the order, the court may make such orders as are provided for in the Rules of the Supreme Court of Virginia and a witness who refuses to testify or produce any evidence described in this section after being ordered to do so by the presiding judge may be held in contempt and may be incarcerated until the contempt is purged by compliance with the order. Subpoenas shall be served and witness fees and mileage paid as allowed in civil cases in the circuit courts of this Commonwealth. Subpoenas issued under this section are expressly excluded and excepted from the provisions of subsection H of 32.1-127.1:03. All records, information, reports, documents, memoranda, and communications created or developed during the course of a civil investigation under this section or pursuant to 32.1-312 shall be considered sensitive and confidential and may be considered attorney work product or privileged investigative files.
25. A provision for the payment of medical assistance for otherwise eligible pregnant women during the first five years of lawful residence in the United States, pursuant to 214 of the Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111-3).
K. The Department of Medical Assistance Services shall require that the actual charge to the program for fee-for-service providers of medical services, equipment, and materials, for which reimbursement is provided under the plan, shall not exceed the lowest price paid to the provider, directly or indirectly, by an individual or entity including, but not limited to, third-party payors, referring providers, cash-paying customers, and managed care providers, for the same or similar service, including all relevant discounts and rebates, with the following exceptions:
1. The Department of Medical Assistance Services, in carrying out its mission to assure that medical care is provided as necessary, may exempt direct medical services provided in person by doctors, nurses, physician's assistants, dentists, dental assistants, and optometrists from the requirements of this provision.
2. Emergency medical services.
3. In the event that any federal regulation, fee schedule, or other requirement indicates that the price should be lower than the actual cost as described above, the Department of Medical Assistance Services shall apply the lower price.