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Last week in the Legislature, more bills were introduced and a few more bills started moving through the process. You may click here for a complete list of all healthcare related bills introduced this Session. |
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Whether it’s President Obama’s statement that Medicare stimulus funds are already flowing through the pipeline, DHHR’s uncertainty over how many strings will be attached or a select House committee determining the devil in the details of the stimulus package, legislators are poised to deal with a fast-moving target as they enter the third full week of their 60-day session.
Many different versions have been reported in the press. Governor Manchin has set up stimulus dollars tracking on his website. As to the health care package, U.S. Senator Jay Rockefeller last week provided this breakdown of dollars flowing into West Virginia under the category of “Essential Services and Health Care for Vulnerable Families”:
- $450 million for a temporary increase in federal Medicaid funding to protect health care coverage for vulnerable populations in West Virginia.
- $585,327 for the West Virginia School Lunch Program.
- $163.6 million in additional Food Stamp assistance for West Virginia families.
- $13 million in Child Care and Development Block Grants to help our families with the high cost of day care.
- $5 million for West Virginia’s Head Start program to enroll more children to help prepare them for school and meet their developmental, educational, health, and nutritional needs.
- $11.2 million in Community Services Block Grants to local West Virginia community action agencies to offer housing and mortgage counseling, jobs skills training, food pantry assistance.
- $289,365 for West Virginia’s Senior Meals on Wheels Program.
- $10.2 million through The Homelessness Prevention Fund to help West Virginians with short or medium-term rental assistance, first and last month’s rental payment, or utility payments.
- In addition, Rockefeller said competitive grant programs can be applied for by West Virginia for high-speed Internet in rural areas, Community Health Center capital funding projects, and electronic health record technologies.
Nationally, The Council of State Governments reports $87 billion to all states combined for Medicaid. All states will receive a bump of 6.2 percent in their federal match (for instance from 50 percent to 56.2 percent), and states with increasing unemployment rates will receive additional funds. Approximately $19 billion is available for health information technology in the American Recovery and Reinvestment Act. Funding incentives to convert to electronic health records are provided for Medicaid providers and hospitals, and other infrastructure investments include broadband construction. One billion is available nationally for disease prevention services. |
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The legislation which came out of the Roadmap to Health Legislative interim project of Select Committee D on Health was introduced this past week. There were rumors circulating the Capitol that the Governor wasn’t supportive of passing the bills however toward week end those rumors had changed. Evidently he is supportive of signing whatever is passed and placed on his desk. The next few weeks will be telling on how much support there is to do some of these proposals.
Medical Home--HB 2743 would establish three different pilot projects for patient-centered medical homes. Patient-centered medical homes strengthen primary care by paying clinics and doctor offices to provide improved patient education and coordination of care. This is an important first step to change our delivery system by putting primary care and prevention at the center of reform efforts.
Tobacco Tax--HB 2746 raises the tobacco taxes for cigarette from 55¢ per pack of cigarettes to the national average of $1.20. Additionally the bill raises the tax from 7% to 14% of the wholesale price for smokeless tobacco products. (This is estimated to equate to the cigarette tax) The tax is projected to raise more than $100 million in new revenue that could fund health care reform and generally boost the State budget.
Calorie Posting--HB 2745 would require chain restaurants (those with 15 or more locations nationwide) to post the number of calories in the food that they sell (not on special menu items though) so that consumers can see the number of calories when they are purchasing the food. West Virginia has the second highest obesity rate in the country, obviously the connection is to think about what you are going to buy to reduce the obesity rate in our state.
Small Business Health Insurance Tax Credit--HB 2744 establishes a tax credit for state-based small businesses. It would allow eligible small group employers (with less than 25 employees) a tax credit of up to 50 percent of the cost of their private health insurance benefit times the percentage of premium cost that is paid by the small group employer. However, the bill limits the total tax credit amounts to no more than $6 million a year and the credits will be provided on a first-come, first-get basis. The bill also limits the total amount of tax credit to $25,000 per employer.
Tax on Health Care Claims for Electronic Medical Records Funding--HB 2747 would place a small fee (2 tenths of one percent) on health care claims to fund health information technology such as electronic medical records. |
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The West Virginia Health Care Authority, chaired by Sonia Chambers, has issued its 2008 Annual Report, which includes a wealth of health facility data from July 1, 2006 through June 30, 2007 (FY 2007). The Authority collects, analyzes and distributes financial information on some 364 health care facilities across the state. These include hospitals, nursing homes, home health agencies, hospices, behavioral health centers and ambulatory surgical centers. The Authority does not collect data on private physician offices. The data are provided to HCA from the facilities per requirements of the Health Care Facilities Financial Disclosure Act.
Click here for the entire 2007 Annual Report.
In the aggregate, the report indicates West Virginia hospitals overall remained relatively stable, reporting profits of $184.5 million, or 4.4% of net patient revenue – up from $176.7 million (4.5% of net patient revenue) in the prior year. Total profit margin for the thirty-five acute care hospitals increased by almost 1 percent. Critical Access Hospitals continued to improve for the fourth straight year, but the state’s psychiatric hospitals had an aggregate loss of $8.3 million, with the two state psychiatric hospitals losing $9.6 million combined and the two private hospitals earning profits of $1.3 million. An aggregate profit of $44.8 million was reported by the state’s 106 nursing homes (an increase over the $32.6 million reported in the previous year). Home health agencies reported total losses of $2.3 million (although 33 of the 72 agencies did show a profit). Hospice profits for the 19 agencies were $8.3 million (down from the previous year) and the aggregate profit for eight methadone treatment facilities was $6.1 million, or 29.7% of total revenue, according to the report.
Combining all reporting health care facilities, the aggregate total of patient service revenue, other operating and non-operating revenue totaled $5.9 billion, an increase of 5.7% over FY 2006. EROE aggregate profits for all facilities combined were $262 million, up 14% from the previous reporting period. According to the FY 2007 report, “hospitals, nursing homes, hospice agencies and behavioral health centers had increased profits. Ambulatory surgery centers’ profit remained stable, while home health agencies decreased their losses”. |
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Legislation to require the state Bureau for Public Health to form a committee to evaluate maternal risk passed the Senate Health Committee on Thursday, February 27. The bill, SB 307, which is supported by the WVSMA and was developed out of a recommendation of the West Virginia Perinatal Partnership, requires the development of a maternal risk screening tool to be used on all pregnant women by their obstetrical providers. The comprehensive risk assessment would enable providers to determine whether the woman or fetus are at increased risk and provides the basis for further assessment and intervention. The bill has a strong confidentiality provision which allows all information derived from the screening tool to remain confidential, even to law enforcement. Confidential uniform data would be collected by the Bureau regarding the medical conditions observed most frequently in pregnant women to better address these concerns. The bill’s second reference to the Finance committee was waived so the bill was sent straight to the floor and is set for passage this week. |
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A bill, SB 231, implementing a new rule promulgated by the State Tax Department (110 CSR 50E) which aims to allow the Medicaid Control Unit access to provider’s tax information hit a big snag this week in the Senate Health Committee. The rule, which moved through the Legislative Rule-Making process this summer, allows the Tax Department to provide all tax related documents to the Medicaid Fraud unit without a court order. When questioned by Senator Evan Jenkins, a representative of the DHHR said argued that it would be a valuable tool for them to use in ferreting out fraud, stating that “people who cheat the Medicaid system are likely cheating others as well”. Senator Evan Jenkins said such an arrangement "would have a chilling effect on Medicaid providers". After nearly an hour of questioning by various members of the Committee at the Tuesday meeting the Committee adjourned and then reconvened on Thursday for further discussion. The members raised concerns about due process and confidentiality and ultimately Committee members' concerns over violating taxpayer privacy trumped potential benefits of the rule.
A motion by Senator Snyder to pass the rule failed on a 4 to 4 vote. Then a motion was made to “pass the bill with recommendation that it do not pass”. That motion passed. Since it is a legislative rule, there are different regulations that govern the passage of rules than bills. All rules must actually “pass”. A committee can not choose to not take up a rule or to kill a bill in committee. However, they can pass it with recommendation it “do not pass”. This rule will now go to the Senate Judiciary Committee, where that Committee may choose to either pass it with or without recommendation that it pass. This is obviously one that we will continue to follow closely. |
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Under a bill, SB 293, the unlawful practice of medicine would move from a misdemeanor to a felony in certain circumstances. This bill is an initiative of the Board of Medicine to more tightly regulate the unlawful practice of medicine. The bill was introduced last year but did not pass. The bill passed the Senate Health Committee and is now in the Judiciary committee.
The bill lays out the following levels:
- Any person who intentionally practices, or holds himself or herself out as qualified to practice, or uses any title, word or abbreviation to indicate to or induce others to believe he or she is licensed to practice a health care profession licensed as an MD with a license classified by the board as expired, lapsed or terminated for any period of time up to three months is guilty of a misdemeanor and, upon conviction thereof, shall be fined not more than $5,000 or confined in jail not more than twelve months, or both fined and confined.
- Any person who practices, or holds himself or herself out as qualified to practice, or uses any title, word or abbreviation to indicate to or induce others to believe he or she is licensed to practice as a physician, podiatrist or physician assistant without an active, valid West Virginia license to practice that profession is guilty of a felony and, upon conviction thereof, shall be fined not more than $10,000 or imprisoned in a state correctional facility for not less than one year nor more than five years, or both fined and imprisoned. It does not include intentionally practicing, holding himself or herself out as qualified to practice or using any title, word or abbreviation to indicate to or induce others to believe he or she is licensed to practice when the practitioner's license is expired, lapsed or terminated, as classified by the board, for any period of time up to three months as addressed in subsection (b) of this section.
- Any person who practices a profession licensed under this article without an active, valid license to practice that profession when such practice results in serious bodily injury is guilty of a felony and, upon conviction thereof, shall be fined not more than $20,000 or imprisoned in a state correctional facility for not less than two years nor more than ten years, or both fined and imprisoned. For purposes of this subsection, "serious bodily injury" means death; brain or spinal damage; disfigurement; fracture or dislocation of bones or joints; limitations of neurological, physical or sensory functions; or any conditions that required subsequent surgical repair.
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Under a bill, HB 2503, which passed the House Health Committee on Wednesday, Feb. 25, all tattoo artists will now be required to inform their customers of the potential that a tattoo may interfere with the clinical reading of a magnetic resonance imaging study, should the patron intending to be tattooed ever encounter a medical need for such a study. This bill was introduced by Delegate Carmichael who said that he had a constituent who was told by a medical provider that her tattoo would interfere with the reading of an MRI and that she also could not receive an epidural due to the location of her tattoo. The bill passed the Health committee and was sent to the Judiciary committee. |
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A bill, HB 2403, which came out of a legislative interim study seeks to implement higher ethical standards upon persons serving on state Boards. The bill clarifies that the members must adhere to the ethical standards required of all state officials and legislators and disallows a board member from concurrently serving as an officer of any state professional association whose mission is, at least in part, to promote the profession regulated by the board on which the member serves.
The bill also clarifies that any person may report to a board information he or she may have that appears to show that a person authorized to practice by the board may have violated the practice act or rules of the board or engaged in practice without regard for the safety and welfare of the public. It further clarifies that a person who is authorized to practice by a particular board, who knows of or observes another person authorized to practice by that same board violating the practice act or rules of the board, or engaging practice without regard for the safety and welfare of the public, has a duty to report the alleged violation to the board. Any person who reports or provides information in good faith is not subject to civil damages.
The bill also requires all members to receive an orientation within two years following their appointment to the Board. The bill passed out of the House Government Organization Committee and also passed the full House on Thursday, February 26. It is now in the Senate Government Organization Committee. |
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The House Finance Committee’s meeting room was packed with legislators and observers last week for the annual budget hearing of the Department of Health and Human Resources. Secretary Martha Walker, accompanied by ten department heads, gave a broad outline of DHHR programs, entities and accomplishments during the past four years. “The next few years will be challenging,” Walker said, “We never know what we’ll face with the uncertain economy”. Walker indicated the states are proceeding with caution as they have not received a great deal of information about forthcoming federal funds. She said there appear to be many “strings attached” to provisions of the federal stimulus package. Overall, however, she maintained there were not a lot of changes in the department’s budget.
Walker said that the Medicaid program is stable, but she noted the number of persons on Medicaid is increasing. Members asked several questions about subjects ranging from electronic technology to increases in child support programs. A great deal of time was spent on behavioral health challenges and the status of rates paid to providers for behavioral medicine services. Director John Bianconi said rates are the same as last year, but, “we would be amiss if we didn’t re-evaluate them, and I have initiated a group to look at this”.
Several delegates probed reports of cutbacks in community services in behavioral medicine around the state. The shortage of foster families and the safety of social workers generally were discussed. A social worker was killed last year while making a Home visit in Cabell County. Delegate Jeff Eldridge suggested investigating some form of constant communication technology between social workers and their offices other than cell phones. Walker said worker safety is an issue and the department is having discussions about the matter with the Office of Technology.
Even though the meeting lasted over two hours, several members had questions regarding the huge agency’s programs. They will put the questions in writing and DHHR will come back for a second time with answers to the specific questions.
The Governor’s Budget bill, which contains the DHHR budget requests, has already been introduced as HB 2010 and SB 150. These bills are now under consideration by the House and Senate Finance Committees. Walker explained that the DHHR budget request is for Fiscal Year (FY) 2010 for the period of July 1, 2009 to June 30, 2010.
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This is the time in the Legislative Session when a lot of work takes place in the respective committees of the House and Senate before being sent to the floor of either House for a final vote. A few bills have passed, but most remain under debate and review by committees. During this past week:
- The House of Delegates passed HB 2504, the “Silver Alert” bill, modeled after the “Amber Alert” program for children. It would create a tracking system and provide media announcements for people who become lost due to cognitive impairments. The bill has passed the house and has been sent to the Senate.
- The Senior Issues Committee in the House passed HB 2444 creating an Oversight Commission on Long-Term Care to address inconsistencies across the state in availability of services. The commission will consist of several members appointed by the Senate President, the House Speaker and the Governor. The bill has been forwarded to House Gov. Organization Committee.
- The House Senior Issues Committee also passed and sent HB 2788 to Judiciary. This is a bill more clearly defining “abuse and neglect” of an elder person or incapacitated adult and adjusted criminal penalties depending on the seriousness of the offense.
- Resurrecting a bill that failed to pass in previous sessions, the House Health Committee recommended for passage of HB 2478, requiring employers working on public improvement projects of $1 million or more to show at least 80% of the employees working on the project are covered by health insurance. The bill now goes to the Judiciary Committee.
- The term “Medicare Advantage Prescription Drug Plan” has been added to the Public Employees Insurance Act under HB 2646. This is a technical amendment to bring the language into conformity with federal language. The Health Committee recommended its passage and it now goes to the Finance Committee for review.
- House Health Committee passed HB 2423 – Relates to Board of Medical Imaging and Radiation Therapy Technology. It is updating the code of this Board which licenses and regulates, MRI Techs, Nuclear Medicine Techs, and Radiologic Technologists.
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Bryan D. Rosen has been appointed Deputy Commissioner for Administration of the Bureau for Medical Services (BMS) of the WV Department of Health and Human Resources. Rosen has 10 years experience with the department and previously served as Director of Financial Services at the Bureau for Public Health and the Director of Budget, Planning and Analysis at BMS. Rosen will be responsible for administration, program integrity and information systems.
Shelly Bastion is currently the Deputy Commissioner for Policy of the Bureau for Medical Services. |
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Governor Joe Manchin promoted the efficiency of electronic medical records, saying they not only can save lives but also curtail the abuse of prescription drugs. According to The Register-Herald, Manchin said, “with electronic records, a pharmacist will be able to see in an instant that another pharmacy has already filled a prescription for another drug within a few days. With this kind of tracking, we will be able to stop those people who go from pharmacy to pharmacy getting access to more prescriptions drugs than they actually need.” He also touted the important of emergency room physicians having immediate online access to medical records of a patient unable to communicate. |
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The House of Delegates last week formally recognized and praised those who worked on the “Campaign for a Healthy Future” project over the last year. Members took note that 60 organizations and individuals came together to push for significant health reform. The resolution, introduced by Chairman Don Perdue and members of the Health Committee, called for access to affordable health care and recognized those who came together to put together the Campaign for a Healthy Future Project.
This project was spearheaded jointly by the AARP and PhRMA. Their purpose was to draw attention to the need for healthcare reform and to support the efforts of the Legislative Roadmap to Health project. |
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The cumbersome process to implement the rules promulgated by state agencies has begun. Rules are made by constitutional officers, cabinet secretaries, major departments, divisions within departments, and by boards, commissions and authorities established by law. The rules provide details for the agencies to handle day-to-day operations issues and implement laws. Note that while all rules-bills listed below were considered by a committee, they all have references to additional committees within their house of origin.
The House Health Committee last week approved and forwarded to Judiciary:
HB 2192 – This bill relates to rules by the Board of Dental Examiners relating to formation and approval of dental corporations.
HB 2205 – Replaces a current legislative rule and more closely reflects national standards for the licensure of Medical Adult Day Care centers. Currently there are no licensed providers of this type in the state.
HB 2208 – DHHR, licensure of child care centers. Permits the center to choose to allow a child to bring food to the centers if the centers have policies that address such issues as which foods are permitted. |
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The House Health Committee laid over HB 2415 that would have added the plant Salvia Divinorum to the list of Schedule I Controlled Substances. Salvia divinorum is a perennial herb in the mint family native to certain areas of the Sierra Mazateca region of Oaxaca, Mexico. The plant, which can grow to over three feet in height, has large green leaves, hollow square stems and white flowers with purple calyces, can also be grown successfully outside of this region. Salvia divinorum has been used by the Mazatec Indians for its ritual divination and healing. The active constituent of Salvia divinorum has been identified as salvinorin A. Currently, neither Salvia divinorum nor any of its constituents, including salvinorin A, are controlled under the federal Controlled Substances Act (CSA).
There have been reports of young people in nationwide and in West Virginia being sold the herb in “novelty stores” or "head shops". The herb is said to induce hallucinogenic psychoactive experiences which last for short durations (5 mis to 1 hour) when smoked or chewed. The herb reportedly is also available on the Internet.
While sheriffs support regulating the substance, the committee is asking that it be further investigated, perhaps with testimony from a neuropharmacologist, to precisely define its effects. Committee member Delegate Manypenny, who is a sponsor of the bill and owns a landscaping company, cautioned against swift action which may impact the ability for persons to have the plan in their landscape. Evidently the plant is not the most common form of Salvia sold and cultivated in West Virginia. A number of states have placed controls on Salvia divinorum and/or salvinorin A. As of December 2008, thirteen states have enacted legislation placing regulatory controls on Salvia divinorum and/or salvinorin A. Delaware, Florida, Illinois, Kansas, Mississippi, Missouri, North Dakota, Ohio, Oklahoma, and Virginia have placed Salvia divinorum and/or salvinorin A into schedule I of state law. California, Louisiana, Maine and Tennessee enacted other forms of legislation restricting the distribution of the plant. The bill was referred to a subcommittee. |
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Phase Two of the “Take Your Best Shot” immunization program was launched at the Capitol last week by the WV Immunization Network. The program targets adolescents to receive up-to-date vaccinations and focuses on HPV, tetanus, diphtheria and pertussis (Tdap), influenza, hepatitis B, measles, mumps and rubella, and chickenpox. Counties participating are Gilmer, Calhoun, Hardy, Braxton, Clay, Boone, Nicholas, Barbour and Monroe. Individuals from county health departments, primary clinics and schools are overseeing the program. The initial launch last year included Kanawha, Lincoln, Tucker, Wayne, Raleigh, Marion and Fayette counties.
First Lady Gayle Manchin praised the program, saying, “By working together, both government and the private sector can have a positive impact on the health of our state’s citizens.” Co-chair Becky King said following Wednesday’s event at the Capitol, “Our goal is to keep moving forward until ‘Take Your Best Shot’ is in each community across West Virginia.” |
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Delegate Craig Blair has stirred conversation at the capitol by raising a controversial subject, mandatory testing of all persons who receive benefits under the Supplemental Nutrition Assistance Program, formerly known as food stamps, unemployment compensation or which could refer to the Temporary Aid to Needy Families program, the Women, Infants and Children program, or both.
The executive committee of the state republican committee endorsed this legislation. Delegate Blair posted his bill, which is yet to be introduced on his Web site www.notwithmytaxdollars.com.
The bill calls for the Division of Human Services to issue random drug tests to be to program beneficiaries. Those who fail would be given a second test in 30 to 60 days. If they fail again, they'll lose their public assistance.
Evidently a similar Michigan law, which was struck down by a court in 2003.
Sen. Clark Barnes, a republican, has raised stiff opposition to the bill. Barnes said he once collected unemployment compensation and food stamps after losing a job in the 1970s, and said, "I can't imagine having to suffer the insult of taking a drug test in addition to that.'' He says Blair's proposal is contrary to the party's stance on constitutional rights and civil liberties. |
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March 02, 2009
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Contacting Your Legislator
The West Virginia Legislature has expanded information available through its Internet web-site www.legis.state.wv.us. On the bottom right of the legislature’s homepage is a spot to enter your zip code. A list of you your elected officials will come up with their contact information.
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