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WV Code § 16-29B-13 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29B. Health Care Authority|§16-29B-13. Review of Final Orders of Board

(a) A final decision of the board and the record upon which it was made shall, upon request of any affected party, be reviewed by the agency of the state designated by the Governor to hear appeals under the provisions of article two-d of this chapter. To be effective, such request must be received within thirty days after the date upon which all parties received notice of the board decision, and the hearing shall commence within thirty days of receipt of the request.(b) For the purpose of administrative review of board decisions, the review agency shall conduct its proceedings in conformance with the West Virginia rules of civil procedure for trial courts of record and the local rules for use in the civil courts of Kanawha County and shall review appeals in accordance with the provisions governing the judicial review of contested administrative cases in section four, article five, chapter twenty-nine-a of this code, notwithstanding the exceptions of section five, article five, chapter twenty-nine-a of this code.(c) The decision of the review agency shall be made in writing within forty-five days after the conclusion of such hearing.(d) The written findings of the review agency shall be sent to all affected parties, and shall be made available by the commission to others upon request.(e) The decision of the review agency shall be considered the final decision of the board; however, the review agency may remand the matter to the board for further action or consideration.(f) Upon the entry of a final decision by the review agency, any affected party may within thirty days after the date upon which all affected parties receive notice of the decision of the review agency, appeal said decision in the circuit court of Kanawha County. The decision of the review agency shall be reviewed by that circuit court in accordance with the provisions for the judicial review of administrative decisions contained in section four, article five, chapter twenty-nine-a of this code.
WV Code § 16-29B-14 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29B. Health Care Authority|§16-29B-14. Injunction; Mandamus

The board may compel obedience to its lawful orders by injunction or mandamus or other proper proceedings in the name of the state in any circuit court having jurisdiction of the parties or of the subject matter, or the Supreme Court of Appeals direct, and such proceeding shall be determined in an expeditious manner.
WV Code § 16-29B-15 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29B. Health Care Authority|§16-29B-15. Refusal to Comply

(a) Whenever a hospital fails or refuses to furnish to the board any records or information requested under the provisions of this article or otherwise fails or refuses to comply with the requirements of this article or any reasonable rule and regulation promulgated by the board under the provisions of this article, the board may make and enter an order of enforcement and serve a copy thereof on the hospital in question by certified mail, return receipt requested.(b) The hospital shall be granted a hearing on the order of enforcement if, within twenty days after receipt of a copy thereof, it files with the board a written demand for hearing. A demand for hearing shall operate automatically to stay or suspend the execution of the order of enforcement, with the exception of orders relating to rate increases.(c) Upon receipt of a written demand for a hearing, the board shall set a time and place therefor, not less than ten and no more than thirty days thereafter. Any scheduled hearing may be continued by the board upon motion for good cause shown by the hospital demanding the hearing.
WV Code § 16-29B-24 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29B. Health Care Authority|§16-29B-24. Reports Required to Be Filed

(a) A covered facility, within one hundred twenty days after the end of its fiscal year, unless an extension be granted by the authority, shall file with the authority its annual financial report prepared by an accountant or auditor.(b) A covered facility, if applicable by legislative rule, shall submit upon request of the authority but at least annually:(1) A statement of charges for all services rendered, except a behavioral health facility shall submit its gross rates for its top thirty services by utilization;(2) The Health Care Authority Financial Report, through the Uniform Reporting System;(3) The current Uniform Bill form in effect for inpatients. This data is not subject to the provisions of subsection (f), section twenty-five of this article.(c) The authority may request from a covered facility, except hospitals, the information from subsection (a) and (b) from its related organization.(d) A home health agency shall annually submit a utilization survey.(e) A covered facility failing to submit a report to the authority shall be notified by the authority and, if the failure continues for ten days after receipt of the notice, the delinquent facility or organization is subject to a penalty of $1,000 for each day thereafter that the failure continues.
WV Code § 16-29B-26 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29B. Health Care Authority|§16-29B-26. Exemptions From State Antitrust Laws

(a) Actions of the authority shall be exempt from antitrust action under state and federal antitrust laws. Any actions of hospitals and health care providers under the authority’s jurisdiction, when made in compliance with orders, directives, rules, approvals or regulations issued or promulgated by the authority, shall likewise be exempt.(b) It is the intention of the Legislature that this chapter shall also immunize cooperative agreements approved and subject to supervision by the authority and activities conducted pursuant thereto from challenge or scrutiny under both state and federal antitrust law: Provided, That a cooperative agreement that is not approved and subject to supervision by the authority shall not have such immunity.
WV Code § 16-29B-30 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29B. Health Care Authority|§16-29B-30. Applicability; Transition Plan

(a) Notwithstanding any provision of this code to the contrary, effective July 1, 2017, the Health Care Authority shall transfer to the Department of Health and Human and Resources. Any and all remaining functions of the Health Care Authority shall transfer at that time to the Department of Health and Human Resources. (b) The Health Care Authority shall develop and implement a transition plan to transfer all their remaining functions to the Department of Health and Human Resources. The plan shall be submitted in writing to the Joint Committee on Government and Finance, the Governor and the Secretary of the Department of Health and Human Resources, the Secretary of the Department of Administration and the Division of Personnel. This plan shall be submitted no later than June 1, 2017. The plan shall include proposals for the following: (1) Transition to appropriate entities or destruction of hard and electronic copies of files; (2) Transfer of all certificate of need matters pending as of July 1, 2017, to the Department of Health and Human Resources. (3) In consultation with the Department of Administration, discontinuation of use of the current building including termination of any lease or rental agreements, if necessary; (4) In consultation with the Department of Administration, disposition of all state owned or leased office furniture and equipment, including any state owned vehicles, if necessary; (5) Closing out and transferring existing budget allocations; (6) A transition plan developed in conjunction with the Division of Personnel for remaining employees not transferred to other offices within state government;(7) A plan to repeal all existing legislative rules made unnecessary by the transfer of the Health Care Authority; and(8) Any other matters which would effectively terminate all functions not transferred to the Department of Health and Human Resources. (9) Upon the effective date of the changes to this article made during the course of the 2017 Regular Session of the Legislature, any function of the Health Care Authority not otherwise eliminated or transferred shall become a function of the Department of Health and Human Resources.
WV Code § 16-29D-1 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29D. State Health Care|§16-29D-1. Legislative Findings; Legislative Purpose

(a) The Legislature hereby finds as follows:(1) That a significant and ever-increasing amount of the state's financial resources are required to assure that the citizens of the state who are reliant on the state for the provision of health care services and payment thereof receive such, whether through the Public Employees Insurance Agency, the state Medicaid program, the workers' compensation fund, the Division of Rehabilitation Services or otherwise;(2) That the state has been unable to timely pay for such health care services;(3) That the Public Employees Insurance Agency and the state Medicaid program face serious financial difficulties in terms of decreasing amounts of available federal or state dollars by which to fund their respective programs and in paying debts presently owed;(4) That, in order to alleviate such situation and to assure such health care services, in addition to adequate funding of such programs, the state must effect cost savings in the provision of such health care;(5) That it is in the best interest of the state and the citizens thereof that the various state departments and divisions involved in such provision of health care and the payment thereof cooperate in the effecting of cost savings; and(6) That the health and well-being of all state citizens, and particularly those whose health care is provided or paid for by the Public Employees Insurance Agency, the state Medicaid program, the workers' compensation fund and the Division of Rehabilitation Services, are of primary concern to the state.(b) This article is enacted to provide a framework within which the departments and divisions of state government can cooperate to effect cost savings for the provision of health care services and the payment thereof. It is the purpose of the Legislature to encourage the long-term, well-planned development of fair, equitable and cost-effective systems for all health care providers paid or reimbursed by the Public Employees Insurance Agency, the state Medicaid program, the workers' compensation fund or the Division of Rehabilitation Services.
WV Code § 16-29D-2 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29D. State Health Care|§16-29D-2. Definitions

(a) "Coordination of benefits" means a provision establishing an order in which two or more insurance contracts, plans or programs covering the same beneficiary pay their claims, with the effect that there is no duplication of benefits.(b) The term "health care" or "health care services" means clinically related preventive, diagnostic, treatment, or rehabilitative services whether provided in the home, office, hospital, clinic or any other suitable place either inside or outside the State of West Virginia provided or prescribed by any health care provider or providers. Such services include, among others, medical supplies, appliances, laboratory, preventive, diagnostic, therapeutic and rehabilitative services, hospital care, nursing home and convalescent care, medical physicians, osteopathic physicians, chiropractic physicians, and such other surgical including inpatient oral surgery, nursing, and podiatric services and supplies as may be prescribed by such health care providers but not other dental services.(c) "Health care provider" means a person, partnership, corporation, facility or institution licensed, certified or authorized by law to provide professional health care services in or outside this state to an individual during this individual's medical care, treatment or confinement. For the sole purpose of this article, pharmacists and pharmacies shall not be considered health care providers.
WV Code § 16-29D-4 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29D. State Health Care|§16-29D-4. Prohibition on Balance Billing; Exceptions

(a) Except in instances involving the delivery of health care services immediately needed to resolve an imminent life-threatening medical or surgical emergency, the agreement by a health care provider to deliver services to a beneficiary of any department or division of the state which participates in a plan or plans developed under section three of this article shall be considered to also include an agreement by that health care provider:(1) To accept the assignment by the beneficiary of any rights the beneficiary may have to bill such division or department for, and to receive payment under such plan or plans on account of, such services; and(2) To accept as payment in full for the delivery of such services the amount specified in plan or plans or as determined by the plan or plans. In such instances, the health care provider shall bill the division or department, or such other person specified in the plan or plans, directly for the services. The health care provider shall not bill the beneficiary or any other person on behalf of the beneficiary and, except for deductibles or other payments specified in the applicable plan or plans, the beneficiary shall not be personally liable for any of the charges, including any balance claimed by the provider to be owed as being the difference between that provider's charge or charges and the amount payable by the applicable department or divisions. The plan or plans may specify what sums are deductibles, copayments or are otherwise payable by the beneficiary and the sums for which the health care provider may bill the beneficiary: In addition, any health care service which is not subject to payment by the plan or plans shall be the responsibility of the beneficiary and for those health care services which are not covered by the plans, there shall be no prohibition against billing the beneficiary directly.(b) The prohibitions and limitations stated in subsection (a) of this section do not apply to the delivery of health care services immediately needed to resolve an imminent life-threatening medical or surgical emergency. However, once the patient is stabilized, then the delivery of any further health care services shall be subject to subsection (a) of this section for those latter services only.(c) The exceptions provided in this section for the delivery of health care services immediately needed to resolve an imminent life-threatening medical or surgical emergency shall not apply to health care providers under contract with a department or division plan or plans.
WV Code § 16-29D-5 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29D. State Health Care|§16-29D-5. Coordination of Benefits

Coordination of benefits is permitted between two or more insurance contracts or employee benefit plans and shall be included for benefits from the Public Employees Insurance Agency and, as appropriate, from the state Medicaid program, the workers' compensation fund and the Division of Rehabilitation Services. Notwithstanding the foregoing, the workers' compensation fund shall be considered the primary payor for health care services related to work-related injuries and diseases ruled compensable as provided in article four, chapter twenty-three of this code. In no event shall the state Medicaid program be considered a primary insurance contract.
WV Code § 16-29D-6 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29D. State Health Care|§16-29D-6. Exemption From and Application of Antitrust Laws

(a) Actions of the departments and divisions of the state, or by officers, administrators, employees, or other agents thereof, shall be exempt from antitrust action as provided in section five, article eighteen, chapter forty-seven of this code. Any actions of health care providers when made in compliance with orders, directives, rules, or regulations issued or promulgated by a department or division which participates in a plan or plans developed under section three of this article shall likewise be exempt.(b) It is the express intention of the Legislature that the actions specified in subsection (a) of this section by either state-related persons or entities or by health care providers should also be deemed to be state actions for purposes of obtaining exemptions from federal antitrust laws.(c) Notwithstanding subsections (a) and (b) of this section, any agreement by two or more persons, partnerships, corporations, facilities or institutions licensed, certified or authorized by law to provide professional health care services in this state to an individual during this individual's medical care, treatment or confinement, unless any of the foregoing are practicing as a partnership or are otherwise associated as a joint venture, to refrain from delivering health care services to any person or persons, which delivery would be subject to the provisions of this article, for the purpose or with the effect of fixing, controlling, or maintaining their charges for the delivery of health care services or for the purpose or with the effect of defeating the purposes of this article shall be deemed to be unlawful under the provision of subsection (a), section three, article eighteen, chapter forty-seven of this code and shall be subject to the remedies and relief provided for in that article and chapter: Provided, That nothing contained in this subsection may prevent any physician on staff of any hospital or other health care institution from discussing with such hospital or health care institution the fact that such physician only consents to see the patient in connection with his or her duties as a staff on-call physician.
WV Code § 16-29D-7 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29D. State Health Care|§16-29D-7. Rules

The secretary of the Department of Health and Human Resources shall promulgate rules to carry out the provisions of this article. The Governor shall establish an advisory committee consisting of at least five individuals representing: An administrator of a small rural hospital; an administrator of a hospital having a disproportionate share of Medicaid or charity care; a registered professional nurse; a physician licensed in this state; and beneficiaries of the plan or plans. The majority of this advisory committee shall consist of health care providers. The purpose of the advisory committee is to advise and assist in the establishment of reasonable payment methods, schedule or schedules and rates. The advisory committee shall serve without compensation; however, the members thereof are entitled to reimbursement of their expenses. The policies and procedures of the rate schedule process setting forth the methodology for determination of rates, payments and schedules are subject to the legislative rule-making procedures of chapter twenty-nine-a of this code: Provided, That emergency rules may be utilized: Provided, however, That the actual rates, payments and schedules themselves shall not be subject to chapter twenty-nine-a of this code.
WV Code § 16-29D-9 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29D. State Health Care|§16-29D-9. Severability; Supersedes Other Provisions

If, for any reason, any part of this article or the application thereof to any person or circumstances is held unconstitutional or invalid, such unconstitutionality or invalidity shall not affect the remaining parts or their application to any other person or circumstance, and to this end, each and every part of this article is hereby declared to be severable. In the event of any inconsistency between the provisions of this article and any other provisions of this code, the provisions of this article shall prevail.
WV Code § 16-29E-1 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29E. Legislative Oversight Commission on Health and Human Resources Accountability|§16-29E-1. Findings and Purpose

The Legislature hereby finds and declares that:(1) A crisis exists in the funding of health and social programs of this state;(2) These programs exist to provide federal and state supported services to citizens in need;(3) The health and well-being of these citizens is jeopardized when uncontrolled growth in various programs uses a disproportionate share of the available funding;(4) State programs are often developed and implemented with limited private or federal grant moneys, which require future funding from the limited state resources; and(5) The problem is exacerbated when various state agencies make competing or conflicting policy decisions.
WV Code § 16-29E-2 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29E. Legislative Oversight Commission on Health and Human Resources Accountability|§16-29E-2. Legislative Intent

It is the intent of the Legislature that all actions taken pursuant to the provisions of this article by the Legislature and the various agencies within the Department of Health and Human Resources serve the following core set of principles:(1) That all health and social programs offered under state authority be coordinated to maximize efficiencies and minimize competition within the various agencies thereby addressing the needs of the citizens more effectively;(2) That communication be facilitated among the various agencies within the Department of Health and Human Resources and between the department and the Legislature;(3) That policy changes, not made by legislative rule, be discussed with the commission for purposes of coordinating those policies with existing programs and stated goals;(4) That programs or policies implemented in accordance with federal mandates be communicated to the commission;(5) That in developing and implementing programs with private or federal grant moneys, the various agencies communicate their efforts to the commission to ensure and facilitate future state funding; and(6) That agencies previously exempted from rule-making review by federal or state statutes advise the commission of program changes which may affect the health and well-being of the citizens of West Virginia.
WV Code § 16-29E-3 (2021)
2021 West Virginia Code|Chapter 16. Public Health|Article 29E. Legislative Oversight Commission on Health and Human Resources Accountability|§16-29E-3. Definitions

As used in this article:(a) "Agency" means those various agencies, authorities, boards, committees, commissions or departments of the Department of Health and Human Resources with authority to promulgate legislative rules pursuant to this chapter that regulate health care providers, practitioners or consumers; or those offering social services programs;(b) "Commission" means the Legislative Oversight commission on health and human resources accountability; and(c) "Department" means the Department of Health and Human Resources.