West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-70 - Primary Care Support Program › Section 64-70-2 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. "Bureau for
				Medical Services" or "BMS" means the division within the West Virginia
				Department of Health and Human Resources (DHHR) that is responsible for
				administration of the Medicaid program in West Virginia.
2.2. "Bureau for Public Health" or "BPH"
				means the division within DHHR that carries out the public health functions of
				DHHR.
2.3. "Director" means the
				commissioner of BPH or his or her lawful designee.
2.4. "Community-Based Board of Directors"
				means a board of directors composed of members who reside within the service
				area of the primary care center under consideration.
2.5. "Federally Qualified Health Center
				(FQHC)" means an entity that meets the United States Health Care Financing
				Administration definition of a federally qualified health center promulgated at
				42 CFR §
										405.2401.
2.6. "Federally Qualified Health Center
				Look-alike" or "Look-alike" means a public or not-for-profit health center that
				meets the eligibility requirements to receive a federal public health services
				grant under the "Public Health Services Act,"
				42 U.S.C. 254b,
				but does not receive grant funding.
2.7. "Nonprofit" means an entity registered
				with the secretary of state as a nonprofit organization and is recognized as
				such for tax purposes or having filed an application for such
				designation.
2.8. "Primary Care
				Center" means an organization which has as its purpose the delivery of primary
				care services.
2.9. "Primary Care
				Service" means a health care service, including medical care, that emphasizes
				first-contact patient care and assumes overall and ongoing responsibility for
				the patient in both health maintenance and treatment of illness. Primary care
				involves a unique interaction between the patient and primary care physician or
				a multi-disciplinary team under the supervision of a physician or both. The
				appropriate use of referrals and community resources is an important part of
				effective primary care. The care is generally provided by a physician but may
				be provided by other members of a multi-disciplinary team such as registered
				nurses, nurse practitioners, physician assistants, and nurse-midwives. The
				purpose of this interaction is to achieve comprehensive coordination of health
				care including educational, behavioral, biological, and social aspects of care.
				It is a patient care-oriented approach which emphasizes the continuity of care
				over the full spectrum of health services. It begins with patient assessment,
				wellness, and prevention through medical management, lifestyle modification,
				and health education. The primary care provider is the patient's advocate
				through the complex system of health care delivery.
2.10. "Program" means the Primary Care
				Support Program within BPH.
2.11.
				"Related Organization" means any organization, whether publicly owned,
				nonprofit tax-exempt, or for profit, related to a primary care center through
				common membership, governing bodies, trustees, officers, stock ownership,
				family members, partners, or limited partners, or a subsidiary, foundation,
				related corporation, joint venture, or other similar organization, if such
				similar organization controls or is controlled by the primary care center
				through contracts, or other legal documents that allow the organization the
				authority to direct any of the primary care center's activities, management, or
				policies. A subsidiary, foundation, related corporation, joint venture, or
				other similar organization shall also be considered a "related organization" in
				the following situations:
2.11.1. The
				subsidiary, foundation, related corporation, joint venture or other similar
				organization has solicited funds in the name of the primary care center with
				the express or implied approval of the primary care center, and any portion of
				the funds were intended by the contributor, or otherwise required to be used,
				for the benefit of the primary care center;
2.11.2. The primary care center has
				transferred or may transfer resources to the subsidiary, foundation, related
				corporation, joint venture, or other similar organization;
2.11.3. The subsidiary, foundation, related
				corporation, joint venture, or other similar organization has transferred or
				may transfer resources to the primary care center, or any of the primary care
				center's resources are held for the benefit of the subsidiary, foundation,
				related corporation, joint venture, or other similar organization;
2.11.4. The primary care center has assigned
				certain of its functions to the subsidiary, foundation, related corporation,
				joint venture, or other similar organization, that is operating primarily for
				the benefit of the primary care center;
2.11.5. The subsidiary, foundation, related
				corporation, joint venture, or other similar organization is wholly owned or
				was created by the primary care center, and the primary care center receives
				any of the profits of the subsidiary, foundation, related corporation, joint
				venture, or other similar organization; or
2.11.6. The primary care center is wholly
				owned or was created by the foundation, related corporation, joint venture, or
				other similar organization, and the foundation, related corporation, joint
				venture, or other similar organization receives any of the revenues of the
				primary care center.