reglab/statecodes huggingface dataset:
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-85 - Alzheimer's/Dementia Special Care Units And Programs › Section 64-85-3 - State Administrative Procedures

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. General licensing provisions.
3.1.a. A facility that proposes to advertise,
				market, or otherwise promote the facility as providing a specialized unit or
				program for residents requiring alzheimer's/dementia care services in an
				alzheimer's/dementia special care unit or program shall first obtain an
				additional license from the secretary, to operate the special care unit or
				program.
3.1.b. A facility shall be
				licensed or eligible for a license as a health care facility in accordance with
				West Virginia law, to operate an alzheimer's/dementia special care unit or
				program. The facility shall meet the requirements of this rule in addition to
				any other applicable federal or state law and rule.
3.1.c. The facility shall make application to
				the secretary, prior to operation and on an annual license renewal application,
				on a form provided by the secretary. The applicant shall complete, sign and
				date the application.
3.1.d. The
				applicant shall submit a disclosure and application for approval, completed on
				forms provided by the secretary.
3.1.e. The secretary may, at his or her
				discretion, deny the application, if the facility is the subject of enforcement
				action by the department or has a history of noncompliance.
3.1.f. Prior to occupancy, the applicant
				shall submit architectural plans for an alzheimer's/dementia special care unit,
				including any new additions or renovations, to the secretary and state fire
				marshal for approval.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-85 - Alzheimer's/Dementia Special Care Units And Programs › Section 64-85-4 - Human Resources

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1.
				Qualifications, Orientation and Training
4.1.a. A designated staff member shall be
				responsible for the coordination of the alzheimer's/dementia special care unit
				or program. The coordinator shall:
4.1.a.1.
				Coordinate as needed outside psychiatric and psychosocial services to assist
				with behavior modification plans;
4.1.a.2. Advocate for resident
				rights;
4.1.a.3. Ensure
				individualized interventions are provided to allow residents to express
				feelings resulting from the disease process, lost roles and life
				status;
4.1.a.4. Obtain and utilize
				a listing of community resources available to residents and family members,
				including alzheimer's networks; and
4.1.a.5. Offer monthly educational and family
				support group meetings.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-85 - Alzheimer's/Dementia Special Care Units And Programs › Section 64-85-5 - Admission, Transfer and Discharge

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Each facility shall have a written
				policy of pre-admission screening, admission, transfer and discharge
				procedures, including an explanation of the level of care the facility is
				licensed to provide and the conditions that may necessitate a resident's
				transfer or discharge.
5.2.
				Admission criteria shall include a signed and dated physician's diagnosis of
				alzheimer's disease or related dementia, a description of any behavioral,
				personality and physical symptoms, medical history, physical exam, and
				treatment plan.
5.3. The facility
				shall base admission decisions on the facility's ability to meet the
				individual's needs, state licensure limitations on the facility's level of
				care, and the availability of licensed nursing staff to provide care.
5.4. Prior to admission, the facility shall
				provide a copy and an explanation of the disclosure statement to the resident
				and/or the resident's legal representative. The facility shall maintain a copy
				of this disclosure, signed and dated by the resident and/or legal
				representative, in the resident's record.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-85 - Alzheimer's/Dementia Special Care Units And Programs › Section 64-85-6 - Assessments and Plans of Care

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. Within three (3) days of admission, the
				unit coordinator, with input from at least the resident and/or the resident's
				legal representative, shall review the immediate care needs of the resident and
				establish a preliminary care plan.
6.2. Within seven (7) days of admission, an
				interdisciplinary team including the unit coordinator, a social worker, the
				activities director, direct care staff and a registered nurse and other
				professional disciplines as appropriate, shall complete an initial assessment
				of a new resident which includes at a minimum: a social history; family
				supports; level of activities of daily living functioning; cognitive level;
				behavioral impairment; and nutritional status, including weight and nutritional
				requirements.
6.3. Within
				twenty-one (21) days of admission the interdisciplinary team and the resident
				and/or the resident's legal representative, shall develop a written
				individualized care plan, signed by each member of the alzheimer's/dementia
				special care unit or program staff, the resident and/or the resident's legal
				representative which shall:
6.3.a. Reflect
				the resident as a person, with family history and interests;
6.3.b. Accurately describe specific needs,
				choices, problems and any inappropriate behaviors;
6.3.c. Describe specific desired outcomes and
				specific interventions to be used to achieve the desired outcomes;
6.3.d. Support the individual toward as much
				independence as possible;
6.3.e.
				Include opportunities for resident choice and self management; and
6.3.f. Contain the job titles of staff who
				are to be primarily responsible for implementing the care plan.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-85 - Alzheimer's/Dementia Special Care Units And Programs › Section 64-85-7 - Behavior Management

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. The
				alzheimer's/dementia special care unit or program shall conduct and document an
				ongoing evaluation of any resident with behaviors, which are persistent and
				constitute sources of distress or dysfunction to the resident, or present a
				danger to the resident or other individuals. The evaluation shall determine the
				following:
7.1.a. A baseline of the
				intensity, duration, and frequency of the behavior;
7.1.b. Antecedent behaviors and
				activities;
7.1.c. Recent changes
				or risk factors in the resident's life;
7.1.d. Environment factors such as time of
				day, staff involved, noise, levels etc.;
7.1.e. The resident's medical
				status;
7.1.f. Staffing patterns at
				times of inappropriate behavior;
7.1.g. Alternative, structured activities or
				behaviors that have been successful or unsuccessful in the past; and
7.1.h. The effectiveness of behavioral
				management approaches.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-85 - Alzheimer's/Dementia Special Care Units And Programs › Section 64-85-8 - Social Services

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. A
				licensed social worker or licensed professional counselor shall be responsible
				for providing the alzheimer's/dementia special care unit or program with the
				following services:
8.1.a. A comprehensive
				social assessment of each resident which includes the following:
8.1.a.1. The resident's preferred
				name;
8.1.a.2. The resident's past
				places of residence;
8.1.a.3. The
				resident's family support system, with names and telephone numbers;
8.1.a.4. The resident's past employment
				status, career history, and educational level;
8.1.a.5. The resident's place of
				birth;
8.1.a.6. The resident's
				childhood history (i.e. rural or city, religion, lifestyle, culture);
8.1.a.7. Languages spoken;
8.1.a.8. Names of the resident's parents,
				children, siblings and legal representative;
8.1.a.9. Names of the resident's pets;
				and
8.1.a.10. The resident's adult
				daily routines (i.e. hour of rising and sleep, habits, etc.);
				and
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-85 - Alzheimer's/Dementia Special Care Units And Programs › Section 64-85-9 - Activities

Current through Register Vol. XLI, No. 28, July 12, 2024
9.1. The
				alzheimer's/dementia special care unit and program shall provide activities
				appropriate to the needs of the individual residents. The residents' routine
				should be developed and structured seven (7) days per week and incorporate the
				possible need for therapeutic programming twenty four (24) hours per day in an
				alzheimer's/dementia special care unit and during the hours of operation of the
				alzheimer's/dementia special care program.
9.2. The activities program shall be directed
				by a person who is a therapeutic recreation specialist, occupational therapist,
				or activities professional who has:
9.2.a.
				Two years of experience in a social or recreational program in the past five
				years, one of which was full-time in a resident activities program in a health
				care setting;
9.2.b. Demonstrated
				the ability to provide for an ongoing program of activities designed to meet
				the residents needs;
9.2.c.
				Completed a training course approved by the state; and
9.2.d. Completed the training required in
				subdivision 4.1.c. of this rule.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-85 - Alzheimer's/Dementia Special Care Units And Programs › Section 64-85-10 - Physical Environment

Current through Register Vol. XLI, No. 28, July 12, 2024
10.1. The
				alzheimer's/dementia special care unit and alzheimer's/dementia special care
				program site shall be designed to accommodate residents with dementia in a
				non-institutional home-like environment. The design and environment shall
				assist residents in their activities of daily living; enhance their quality of
				life, reduce tension, agitation, and problem behaviors, and promote their
				safety.
10.2. In addition to the
				physical design standards required for the facility's license, an
				alzheimer's/dementia special care unit and program site shall have the
				following:
10.2.a. A floor plan design with
				limited access to the designated area so that visitors and staff do not pass
				through the unit to get to other areas of the facility;
10.2.b. A multipurpose room for dining, group
				and individual activities and family visits which complies with the facility's
				applicable licensing requirements for common space;
10.2.c. Security measures to provide for the
				safety of wandering residents that are as unobtrusive as possible;
10.2.d. High visual contrasts between floors
				and walls, and doorways and walls in resident use areas. Except for fire exits,
				door and access ways may be designed to minimize contrast to obscure or conceal
				areas the residents should not enter;
10.2.e. Non-reflective floors, walls and
				ceilings which minimize glare;
10.2.f. Evenly distributed lighting which
				minimizes glare and shadows and is designed to meet specific needs of the
				residents;
10.2.g. A monitoring or
				nurses' station, which includes a communication system such as a telephone or
				two-way voice actuated call system to the main staff station of the facility,
				and space for charting and storage for resident records; and
10.2.h. Secured outdoor space and walkways
				which allow residents to ambulate but prevent undetected egress.
10.2.h.1. Outdoor areas shall have fencing or
				barriers that prevent elopement and do not have features that pose a threat to
				resident safety.
10.2.h.2. Walkways
				shall meet the accessibility requirements of the Americans with Disabilities
				Act (ADA) structural building codes.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-85 - Alzheimer's/Dementia Special Care Units And Programs › Section 64-85-12 - Administrative Due Process

Current through Register Vol. XLI, No. 28, July 12, 2024
12.1.
				Administrative due process and remedies for actions taken under this rule, are
				set forth in the West Virginia Department of Health and Human Resources
				Administrative Rules, Rules of Procedure for Contested Case Hearings and
				Declaratory Rulings, 64CSR1 and W. Va. Code §§
									29A-4-1,
				et seq. and 29A-5-1, et seq.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-86 - Surrogates For Incapacitated Persons In Health Care Facilities Operated By The Department Of Health And Human Resources › Section 64-86-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				legislative rule designates individuals and entities who are authorized to act
				as surrogates for incapacitated persons in the Department's health care
				facilities. This rule should be read in conjunction with W. Va. Code §
									16-30-8
				and the definitions in W. Va. Code §
									16-30-3.
				The W. Va. Code is available in public libraries and on the Legislature's web
				page:
http://www.legis.state.wv.us/
.
1.2. Authority. -- W. Va. Code §
									16-30-8(a)(7).
1.3. Filing Date. -- April 4, 2003.
1.4. Effective Date. -- July 1,
				2003.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-86 - Surrogates For Incapacitated Persons In Health Care Facilities Operated By The Department Of Health And Human Resources › Section 64-86-2 - Application and Enforcement Section

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. Application. -- This rule applies to
				incapacitated persons who are in need of surrogates and who are patients in the
				Department's health care facilities; Department designated surrogates; health
				care facilities; health care providers; and individuals and entities who are
				prohibited from serving as surrogates.
2.2. Enforcement. -- This rule is enforced by
				the Commissioner of the Bureau for Public Health or his or her
				designee.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-86 - Surrogates For Incapacitated Persons In Health Care Facilities Operated By The Department Of Health And Human Resources › Section 64-86-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. The
				definitions in W. Va. Code §
									16-30-3
				apply to this rule.
3.2.
				Department. -- The West Virginia Department of Health and Human
				Resources.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-86 - Surrogates For Incapacitated Persons In Health Care Facilities Operated By The Department Of Health And Human Resources › Section 64-86-4 - Designation of Individuals and Entities

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. The following are designated as
				individuals and entities that may be selected in accordance with W. Va. Code
				§
									16-30-8(a)(7)
				as surrogates for patients in the Department's health care facilities:
4.1.a. Any organization authorized under
				state or federal laws, or under contract with the Department, to advocate for
				individuals in the Department's health care facilities;
4.1.b. Any organization authorized under
				federal or state laws, or under contract with the Department, to provide
				surrogacy, guardianship or conservator services for persons in the Department's
				health care facilities; and
4.1.c.
				Any Department employee not otherwise precluded from serving as a surrogate by
				the provisions of W. Va. Code §
										16-30-8(i).
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89 - Uniform Credentialing Of Health Care Practitioners › Section 64-89-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				rule establishes requirements relating to the use of uniform credentialing and
				recredentialing forms in this State. The W. Va. Code is available in public
				libraries and on the Legislature's web page,
http://www.legis.state.wv.us/
.
1.2. Authority. -- W. Va. Code §§
									16-1A-2
				et seq.,
				16-1-4
				and
				33-2-10.
1.3. Filing Date. -- April 22,
				2005.
1.4. Effective Date. -- April
				22, 2005.
1.5. This is a joint rule
				of the Department of Health and Human Resources and the West Virginia Insurance
				Commission.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89 - Uniform Credentialing Of Health Care Practitioners › Section 64-89-2 - Application

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. Except as
				otherwise provided, this rule applies to all hospitals, insurers, managed care
				organizations, third party administrators, other health care entities that
				credential health care practitioners in this state and all health care
				practitioners designated by the secretary and commissioner.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89 - Uniform Credentialing Of Health Care Practitioners › Section 64-89-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. "Commissioner"
				means the commissioner of insurance.
3.2. "Committee" means the uniform
				credentialing advisory committee established pursuant to W. Va. Code §
									16-1A-3.
3.3. "Credentialing" means the process of
				assessing and validating the qualifications of a health care practitioner,
				including but not limited to, an evaluation of licensure status, education,
				training, experience, competence and professional judgment.
3.4. "Health Care Entity" means any of the
				following that require the submission of credentials data:
3.4.a. A clinic or other health care facility
				or organization licensed or certified to provide medical or health care
				services in this state;
3.4.b. A
				hospital;
3.4.c. A managed care
				organization;
3.4.d. A third party
				administrator;
3.4.e. An
				insurer;
3.4.f. A certified
				verification organization or any other entity to whom the duties of
				credentialing or recredentialing have been delegated by another health care
				entity; and
3.4.g. Any other
				organization that contracts with health care practitioners for health care
				services and, in the course of its operations, requires practitioners to
				provide credentialing information.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89 - Uniform Credentialing Of Health Care Practitioners › Section 64-89-4 - Mandatory Use of Uniform Credentialing Form and Uniform Recredentialing Form

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. Beginning July
				1, 2003, all health care entities shall use the uniform credentialing form
				developed by the committee for credentialing health care practitioners and the
				uniform recredentialing form developed by the committee for recredentialing
				health care practitioners.
No health care entity may require any health care
				  practitioner credentialed by that health care entity prior to July 1, 2003 to
				  reapply using these forms until the date on which the health care practitioner
				  would otherwise be required to reapply or provide updated credentialing
				  information.
4.2. The
				health care practitioners who are required to use the uniform credentialing and
				uniform recredentialing forms are those designated by the secretary and
				commissioner.
4.3. Once the health
				care practitioner has completed the uniform credentialing and/or uniform
				recredentialing forms, he or she may duplicate the forms as necessary for
				submission to multiple health care entities. The forms shall be accompanied by
				the following:
4.3.a. An affirmation or
				attestation page that bears an original signature and date and that verifies
				the accuracy of the information on the form as of the date it is signed;
				and
4.3.b. An original signed
				authorization to release information to the health care entity relating to the
				professional qualifications, ethical standing, competence, and mental and
				physical health of the health care practitioner.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89 - Uniform Credentialing Of Health Care Practitioners › Section 64-89-5 - Amendment of Uniform Credentialing and Uniform Recredentialing Forms

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. The secretary
				and the commissioner shall reconvene the committee at least annually to review
				and recommend any necessary amendments to the uniform credentialing form, the
				uniform recredentialing form or the list of health care practitioners who must
				use the uniform forms.
5.2. The
				secretary and the commissioner may, upon recommendation by the committee,
				jointly propose amendments to the uniform credentialing form, the uniform
				recredentialing form or the list of health care practitioners.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89 - Uniform Credentialing Of Health Care Practitioners › Section 64-89-6 - Confidentiality of Credentialing and Recredentialing Data

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. Any credentials data collected or
				obtained by a health care entity during the credentialing or recredentialing
				process shall constitute confidential peer review information, as provided by
				W. Va. Code §
									30-3C-3,
				and shall not be disclosed by the health care entity except as provided by
				law.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89 - Uniform Credentialing Of Health Care Practitioners › Section 64-89-7 - Delegation of Credentialing or Recredentialing Activities

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. Nothing in this rule may be construed to
				prohibit a health care entity from delegating credentialing or recredentialing
				activities to another entity, such as a certified verification organization, as
				long as the entity to whom the activities have been delegated follows the
				requirements of this rule.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89 - Uniform Credentialing Of Health Care Practitioners › Section 64-89-8 - Violation

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. Complaints and
				allegations of violations of this rule may be filed with either the secretary
				or the commissioner. If the agency to whom the complaint is addressed
				determines it to be more appropriate for the other agency to process it, then
				the secretary or the commissioner may refer it to the other agency for
				processing.
8.2. Notwithstanding
				any penalty provisions set forth in W. Va. Code §§
									16-1-18
				or
				33-3-11,
				any health care entity that violates the provisions of this rule is subject to
				the following:
8.2.a. An award of actual
				damages established by the health care practitioner, payable to that health
				care practitioner; and/or
8.2.b. An
				administrative penalty, payable to the either the Department of Health and
				Human Resources or the Commissioner, whichever receives the complaint or
				pursues the action, but not both, in an amount of not less than five hundred
				(500) dollars and not more than five thousand (5,000) dollars.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89A - Forms Applicable To The Uniform Credentialing Of Health Care Practioners › Section 64-89A-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				procedural rule, a joint rule of the Department of Health and Human Resources
				and the West Virginia Insurance Commission, amends the uniform application
				forms required to be used for credentialing and recredentialing health care
				practitioners, and incorporates into this procedural rule those uniform
				application forms and the list of health care practitioners who must use the
				forms.
1.2. Authority. -- W. Va.
				Code §§
									16-1A-2,
				16-1A-3(c),
				16-1-4
				and
				33-2-10.
1.3. Filing Date. -- September 27,
				2004.
1.4. Effective Date. --
				October 28, 2004.
1.5. This is a
				joint rule of the Department of Health and Human Resources and the West
				Virginia Insurance Commission.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89A - Forms Applicable To The Uniform Credentialing Of Health Care Practioners › Section 64-89A-2 - Applicability

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1. Except as
				otherwise provided, this rule applies to all hospitals, insurers, managed care
				organizations, third party administrators, or other health care entities that
				credential health care practitioners in this state and all health care
				practitioners listed in Appendix C of this rule. This procedural rule shall be
				read in pari materia with the rule entitled uniform credentialing of health
				care practitioners (64CSR89, §1, et seq.), which is a joint legislative
				rule promulgated by the Insurance Commissioner and the Secretary of the
				Department of Health and Human Resources pursuant to authority granted by the
				legislature in W. Va. Code §
									16-1A-2.
				All of the provisions provided in 64CSR89, §1, et seq., are equally
				applicable to this procedural rule. W. Va. Code §
									16-1A-3(c)
				authorizes the Insurance Commissioner and the Secretary of the Department of
				Health and Human Resources to amend the uniform application forms and list of
				health care practitioners who must use the forms by procedural, rather than
				legislative, rule. This procedural rule amends the uniform forms required to be
				used for credentialing and recredentialing health care practitioners, and
				incorporates the uniform forms as well as the list of health care practitioners
				who must use the forms into this procedural rule. Upon the effective date of
				this procedural rule, the forms and lists attached to this procedural rule as
				Appendix A, Appendix B, and Appendix C, will apply to the credentialing and
				recredentialing of health care practitioners in this state.
Click Here To
				  View Image
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89B - Credentialing Verification Organization › Section 64-89B-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- The
				purpose of this rule is to establish criteria for the selection of the
				statewide credentialing verification organization (CVO) and to establish
				guidelines for the CVO's activities.
1.2. Authority. -- W. Va. Code §§
									16-1A-9
				and
				33-2-10.
1.3. Filing Date. -- April 20,
				2012.
1.4. Effective Date. -- July
				1, 2012.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89B - Credentialing Verification Organization › Section 64-89B-3 - Selection of the Credentialing Verification Organization

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. On or before July 1, 2012, the Secretary
				and Commissioner shall form a three-person evaluation committee to take the
				necessary actions for the selection of a statewide CVO. The Secretary and
				Commissioner shall each select one member of the committee, and these two
				members shall select the third member; this committee will act on behalf of the
				two agencies during the purchasing process through the award of the contract.
				The Uniform Credentialing Committee will serve as an advisor to such evaluation
				committee.
3.2. The evaluation
				committee will seek approval to select a statewide CVO through the RFP process
				and, if approved, may use the RFP process for the planning phase prior to
				writing the contract specifications, including use of a Request for Information
				(RFI) to conduct market research to obtain additional information from other
				agencies, vendors and public and private entities.
3.3. On or before January 1, 2013, the
				evaluation committee will submit an RFP to the Purchasing Division for release
				pursuant to Purchasing Division procedures. This RFP shall include a preference
				for in-state vendors and may permit the opportunity for a Pre-bid
				Conference.
3.4. In its response to
				the RFP, an applicant must, at a minimum, demonstrate that it:
3.4.a. Meets NCQA's Core Requirements in the
				Standards & Guidelines for Certification of Credential Verification
				Organizations for all standards related to "Written Policies and Procedures"
				and "Protecting Credentialing Information";
3.4.b. Is currently accredited by NCQA as
				meeting the following certification options: License to Practice; DEA
				Certification; Education and Training; Malpractice Claims History; CVO
				Application and Attestation Content; Application Processing; Medicare/Medicaid
				Sanctions; Medical Board Sanctions; Ongoing Monitoring of Sanctions; and Work
				History;
3.4.c. Is able to
				demonstrate compliance with the Joint Commission's standards for credentialing
				and with all federal and state credentialing regulations; and
3.4.d. Maintains an errors and omissions
				insurance policy in amounts deemed to be adequate by the Secretary and
				Insurance Commissioner in the RFP.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89B - Credentialing Verification Organization › Section 64-89B-4 - Duties and Timelines of the Credentialing Verification Organization

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. The CVO shall
				be responsible for accepting and processing all credentialing applications
				required of health care practitioners, including verification of all
				credentialing information by generally accepted procedures endorsed and
				certified by NCQA, the Joint Commission and other relevant regulatory agencies.
4.1.a. All verifications shall be
				electronically recorded in order to document the specific verification query,
				request attempt type, date and number and response information.
4.1.b. When primary source verification is
				not obtainable due to circumstances outside the CVO's control, such as facility
				closures or missing and inaccessible records, this will be noted in the
				practitioner's electronic and paper file and will appear on the CVO's
				verification printout.
4.1.c.
				Initial verification profiles of new credentialing applicants shall be
				completed by CVO within 30 days after its receipt of a completed and clean
				credentialing application form. The CVO shall have procedures in place to
				provide expedited processing of initial applications upon request by the
				practitioner or credentialing entity.
4.1.d. After a practitioner's initial
				credentialing application has been completed and verified, subsequent requests
				for completed verifications profiles shall be delivered to requesting
				credentialing entity, with prior release and authorization, within 15 days of
				request, with allowances for emergency expedited requests.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89B - Credentialing Verification Organization › Section 64-89B-5 - Fees

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. The CVO shall
				establish a reasonable fee schedule for credentialing entities' use of the
				credentialing services provided and shall include such schedule in its RFP
				response.
5.1.a. The fee schedule should be
				comparable to that used by other vendors providing comparable credentialing
				services.
5.1.b. Any increase in
				fees must be approved by the Secretary and Commissioner in accordance with the
				state Purchasing Division's procedures for amendments of contracts and after
				consultation with the advisory committee during the RFP process.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89B - Credentialing Verification Organization › Section 64-89B-6 - Enforcement

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. Beginning July
				1, 2015, or as soon thereafter as a contract with a statewide CVO has been
				executed, all credentialing entities shall use the statewide CVO in their
				credentialing and recredentialing processes for the primary source verification
				of credentialing information.
6.2.
				Each practitioner subject to credentialing shall submit an application and such
				credentialing information as the CVO may request; the CVO may terminate the
				credentialing process on the basis of a practitioner's unjustified failure to
				submit information within a period of 30 days of a request and may retain any
				fees paid by the practitioner and the credentialing entity.
6.3. Violations of this rule by an insurer
				may be enforced by the Commissioner pursuant to the sanctions and penalties set
				forth in W. Va. Code §
									33-3-11.
6.4. Complaints and allegations of violations
				of this rule may be filed with either the Secretary or Commissioner, each of
				whom may refer any such complaint to the other if he or she determines it to be
				more appropriate for the other agency to process it.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89B - Credentialing Verification Organization › Section 64-89B-7 - Use and Maintenance of Confidential Data Gathered by the CVO

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. The CVO shall
				establish and maintain procedures that ensure the confidentiality and integrity
				of all practitioners' credentialing information in accordance with standards
				promulgated by NCQA, the Joint Commission and any applicable state and federal
				regulatory agencies.
7.2. The CVO
				shall develop procedures to ensure that credentialing information is only
				provided to the applicable practitioner and to credentialing entities after a
				complete and valid practitioner's authorization and release has been obtained
				and is on file.
7.3. Credentialing
				information shall not be used for any purposes other than review by
				credentialing entities of the professional background, competency and
				qualifications, and credential or the renewal of credentials of a health care
				practitioner or appeals there from except as provided in subsection 7.4 of this
				section. All credentialing information is exempt from disclosure under the
				provisions of the Freedom of Information Act and from disclosure pursuant to
				civil law subpoena and discovery processes.
7.4. Credentialing information may be
				disclosed in the following circumstances:
7.4.a. In appeals of credentialing decisions
				or to peer review and quality improvement committees, subject to protections
				provided in W. Va. Code §
										30-3C-3;
7.4.b. In matters in which an action or order
				of a professional licensing board or other state or federal regulatory agency
				is at issue, including any proceeding brought by or on behalf of a health care
				practitioner or a patient or by a regulatory body that challenges the actions,
				omissions or conduct of a credentialing entity with respect to a credentialing
				decision, or;
7.4.c. When
				authorized by the health care practitioner to whom the credentialing
				information relates, but only to the extent that the disclosure is information
				that the practitioner provided directly to the statewide CVO.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-89B - Credentialing Verification Organization › Section 64-89B-8 - Recredentialing

Current through Register Vol. XLI, No. 28, July 12, 2024
8.1. Except as
				provided in subsection 8.3 of this section, during the third year after the
				completion of a practitioner's initial credentialing, each practitioner is
				subject to recredentialing by the last day of the practitioner's birth month
				and by the same date every third year thereafter.
8.2. The CVO shall be responsible for
				notifying each practitioner of their recredentialing date in a timely
				manner.
8.3. In order to
				accommodate health care facilities with recredentialing schedule variances,
				these credentialing entities are responsible for monitoring their credentialing
				profiles with their internal credentialing schedules and for notifying their
				practitioners of their recredentialing dates.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-91 - Newborn Screening System › Section 64-91-1 - General

Current through Register Vol. XLI, No. 28, July 12, 2024
1.1. Scope. -- This
				rule directs the Bureau for Public Health, in cooperation with other state
				agencies and attending physicians, to provide medical, dietary, and related
				assistance to children determined to be afflicted with any disease specified in
				W. Va. Code §16-22-3, and certain other
				diseases specified by the Bureau for Public Health. The rule provides for a
				means of payment for the required screenings, and any further referral or
				treatment services considered necessary by the Bureau for Public Health to
				implement the provisions of the statute on newborn screening. This rule should
				be read in conjunction with W. Va. Code §16-22-3 and §16-22A-1
et seq.
and the rule on Newborn Hearing Screening, 64CSR24.
				The W. Va. Code is available in public libraries and on the Legislature's
				website,
http://wvlegislature.gov/
1.2. Authority. -- W. Va. Code
				§16-1-4, §16-22-3 and
				§16-22A-3.
1.3. Filing Date.
				-- May 1, 2024.
1.4. Effective
				Date. -- May 1, 2024.
1.5. Sunset
				Provision. -- This rule shall terminate and have no further force or effect on
				August 1, 2029.
1.6. The fee for a
				newborn screening system kit established in section 6 of this rule supersedes
				the amount in the Bureau for Public Health's "Fees for Services" rule, 64CSR51,
				Appendix A.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-91 - Newborn Screening System › Section 64-91-2 - Application and Enforcement

Current through Register Vol. XLI, No. 28, July 12, 2024
2.1.
				Application. -- This rule applies to all infants born in West Virginia and to
				the hospital or birthing facility in which an infant is born, the parents or
				legal guardians, the physician attending a newborn child, or any person
				attending a newborn child not under the care of a physician and the director of
				the state laboratory performing mandatory newborn screening tests.
2.2. Enforcement. -- This rule is enforced by
				the Commissioner of the Bureau for Public Health.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-91 - Newborn Screening System › Section 64-91-3 - Definitions

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Birthing
				Facility. -- Any licensed medical facility that offers birthing
				services.
3.2. Bureau. -- The
				Bureau for Public Health in the West Virginia Department of Health and Human
				Resources. The bureau is the agency responsible for administering the Newborn
				Screening System.
3.3. Commissioner
				-- The Commissioner of the Bureau for Public Health or his or her
				designee.
3.4. Newborn Screening.
				-- The statutorily mandated screening of newborns by hospitals, birthing
				facilities, physicians or others.
3.5. Newborn Screening System. -- The
				coordinated effort by the bureau and West Virginia physicians who deliver and
				care for children, to ensure that each newborn child is screened for metabolic
				disorders before discharge from birthing facilities. Infants identified with a
				disorder must receive continuing care and treatment provided through a
				collaborative effort between the primary physician, medical specialist, the
				bureau, and community support services.
3.6. Office of Maternal, Child and Family
				Health. -- The office in the bureau that provides coordination and leadership
				in working with public and private community partners and families to assure
				the availability and use of health care for all mothers, infants and children
				including children with special health care needs.
3.7. Primary Care Provider. -- The physician,
				physician's assistant, nurse, nurse practitioner or other licensed medical
				professional responsible for the infant's health services during and/or after
				discharge from the birthing facility.
3.8. State Laboratory. -- The Department of
				Health and Human Resources, Bureau for Public Health's Office of Laboratory
				Services, that supplies newborn screening services to all birthing facilities
				in the state.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-91 - Newborn Screening System › Section 64-91-4 - When Screening is Required

Current through Register Vol. XLI, No. 28, July 12, 2024
4.1. W. Va.
				Code §16-22-3 requires that all infants
				born in the state be screened for detection and control of diseases in newborn
				children as listed in section 5.
4.2. When the birth takes place in a licensed
				birthing facility the primary care provider must perform or cause to be
				performed newborn screening as listed in section 5 within 48 hours of birth, or
				before discharge from the birthing facility, whichever comes first.
4.3. If an infant is born in a non-hospital
				or non-birthing facility, including a home, the person in attendance at the
				birth must perform or cause to be performed the newborn screening as listed in
				section 5 within 48 hours of the birth.
4.4. If a specimen is unacceptable or a
				positive screen result occurs, the primary care provider must perform or cause
				to be performed a second screen.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-91 - Newborn Screening System › Section 64-91-5 - Complete list of diseases and conditions

Current through Register Vol. XLI, No. 28, July 12, 2024
5.1. Every infant born in West Virginia must
				be screened for the diseases and conditions contained in this
				section.
5.2.
				Adrenoleukodystrophy
5.3.
				Argininosuccinic acidemia, ASA;
5.4. Beta-ketothiolase deficiency,
				BKT;
5.5. Biotinidase deficiency,
				BIOT;
5.6. Carnitine uptake defect,
				CUD;
5.7. Citrullinemia,
				CIT;
5.8. Congenital adrenal
				hyperplasia, CAH;
5.9. Cystic
				fibrosis, CF;
5.10 Galactosemia,
				GALT;
5.11. Glutaric acidemia type
				I, GAI;
5.12. Hearing deficiency,
				HEAR;
5.13. Hemoglobinopathies;
				including:
5.13.a. Hemoglobin
				S/Beta-thalassemia, Hb S/Th;
5.13.b. Sickle cell anemia, Hb SS;
5.13.c. Sickle C disease, Hb S/C;
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-91 - Newborn Screening System › Section 64-91-6 - Screening Protocol

Current through Register Vol. XLI, No. 28, July 12, 2024
6.1. The
				primary care provider must perform, or cause to be performed, newborn screening
				listed in section 5 shortly after birth and before discharge from the birthing
				facility and send the specimen to the state laboratory to perform the
				tests.
6.2. The screening must be
				performed by trained personnel, according to the Clinical Laboratory
				Improvement Amendments (CLIA) standards as recommended by the American Academy
				of Pediatrics.
6.3. The
				Commissioner may update or modify the screening procedures according to
				screening protocol, technology, and current national standards.
6.4. If the primary care provider is unable
				to screen or cause to have screened the infant before discharge, then the
				primary care provider must refer the infant for an outpatient newborn
				screening.
6.5. For infants born in
				a non-hospital or non- birthing facility, including a home, the primary care
				provider must order an outpatient newborn screen.
6.6. A specimen must be collected on
				collection kits obtained through the state laboratory.
6.7. A specimen must be submitted to the
				state laboratory within 24 hours of collection through the U.S. mail or have
				the specimen ready for pick-up by courier service at a designated time and
				location.
West Virginia Code of State Rules › Agency 64 - Health › Title 64 - LEGISLATIVE RULE WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES › Series 64-91 - Newborn Screening System › Section 64-91-7 - Screening Fee Schedule

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. The
				bureau may bill the birthing facility or individual attending the birth for
				services provided for each newborn screen consistent with prevailing health
				insurance reimbursement rates for newborn screening to cover the
				administrative, laboratory, and follow-up costs associated with the performance
				of screening tests required by this rule.
7.2. No newborn may be denied testing
				required by this rule because of inability of the newborn's parents or legal
				guardian to pay the prescribed fee.
7.3. The bureau will periodically review the
				newborn screening program to determine the efficacy and cost-effectiveness of
				the program and determine whether adjustments to the program are necessary to
				protect the health and welfare of this state's newborns, and to maximize the
				number of newborn screenings that may be conducted with the funding available
				for the screenings.
7.4. The bureau
				shall prepare an annual report to be submitted to the legislature, and to be
				made available to any interested party, that will include actual expenses
				incurred and revenue generated by the newborn screening system each
				year.