WV Executive

THE WEST VIRGINIA LEGISLATURE will be challenged to design a health care delivery model to meet the needs of the 21st Century by providing quality, accessible and affordable health care in both the private and public health care delivery sectors. In light of the fact that our state ranks first in overall disability rate, hypertension and the rate of cancer-related deaths from colorectal cancer, ranks third in obesity and has an aging population, the legislature is working hard during the interim period to address these issues in preparation for the 2009 session.

The Roadmap to Health/Health Care Reform Initiative in West Virginia was instituted and funded over a year ago with the intent of developing a state-of-the-art health care delivery system. Del. Don Perdue (Wayne), co-chair of the Senate Health and Human Resources Committee, and I have invited members of the Governor’s office, the business community, the labor community, health care providers, special interest groups and the public sector to participate in this collaboration in an effort to bring sustainable change to our health care system in West Virginia.

Under the consultation and guidance of Kenneth E. Thorpe, Ph.D. of Emory University, The Roadmap to Health Initiative was divided into four major workgroups: Administrative Simplification, headed by Carl Callison, Mountain State Blue Cross Blue Shield; Health Information Technology and Chronic Care, headed by Dr. James Comerci; Health Care System Redesign, headed by Tom Susman, TSG Solutions and Wellness and Prevention, headed by Keri Kennedy, WVDHHR. The working groups were provided guidelines to design solutions to reduce the growth in health care spending, increase access to health care services among the uninsured and improve the quality of care provided. The Roadmap to Health

The Roadmap to Health group submitted recommendations for legislation that included:

• A modification of the definition of a medical home to provide a more comprehensive team approach to a patient-centered medical home. This initiative will start with pilot projects and expand statewide as it becomes more feasible.
• A single state entity, with no more than three regional sites, to provide eletronic access, verification and administration of provider credentialing.
• Menu labeling of caloric information at the point of purchase in chain restaurants that will provide consumers with a more informed choice for health foods.

The health committees will explore a universal wellness and health program to benefit certain eligible uninsured individuals under 250 percent of the federal poverty level, with an individual care plan and appropriate medical treatment of common chronic medical conditions. Consideration will be given for the institution of an office in the executive branch for governance, cross agency coordination and capacity to implement the full range of health care reform activities.

Fiscal issues for discussion will include the following topics: to implement a small total claims assessment percentage of insurance carriers that would be allocated for advancement of health information technology/electronic medical records and tax incentives to create bottom-level funding for electronic medical record adoption in individual physician offices and clinics; tax incentives/tax credits of up to 50 percent of the costs of the PEIA health insurance benefit for small businesses with 25 or less workers that do not currently provide health insurance if 75 percent if the workers participate in the plan and, finally, consideration of an increase in the tobacco tax with new revenues to be dedicated toward the fight of chronic disease within the state.

Much debate has been voiced over the role of the Pharmaceutical Cost Management Council. Pursuant to a Performance Evaluation and Research Division Audit, it is recommended that the Cost Management Council be terminated, be re-established as advisory to the Office of the Pharmaceutical Advocate or be restructured as more consumer-oriented. Also, it is proposed that the current rule-making authority that rests with the Council, which requires pharmaceutical companies to report advertising expenses to the Council, would be moved to the Health Care Authority. This will all require legislative action.

A sub-committee has been reviewing options with West Virginia’s Certificate of Need (CON) statute over the past two interim sessions and will have recommendations for passage during the 2009 session. On the table are issues relative to dealing with hospitals that have experienced financial issues they believe stem from CON because of their proximity to a border state. This is particularly true with those that border states that do not have Certificate of Need, particularly Ohio and Pennsylvania. Current code requires that any capital expenditure by a hospital in excess of $2 million is subject to CON. This has not been changed since 1999, and there is a move to raise this to at least $2.5 million.

Governor Joe Manchin has given some early indication that he intends to introduce legislation to provide greater insurance coverage to uninsured West Virginians. This would likely be an expansion of Medicaid. Currently, children are covered at 100 percent of the federal poverty level and adults with children are eligible at 17 percent of the federal poverty level. To increase these levels, it would require an increase in state funding, a statutory change regarding eligibility requirements and federal approval—possibly a new Medicaid wavier. The Governor’s plan may also result in an increase in SCHIP eligibility. Currently, state code authorizes them to go up to 300 percent of the federal poverty level. The current level is set at 250 percent. The SCHIP expansion would be a policy and not a statutory shift.

Other issues that are likely to be debated during the upcoming session are the parental notification issue, the management of pain issue and the scope of practice issue. The parental notification bill is introduced every year. It has a history of passing the Senate but has not been successful in passing through the House of Delegates. The management of pain issue would require a change in the statutory definition of pain that would bring West Virginia in line with other states. It would shift our focus from health care spending on the end of life to chronic diseases and make us a more healthy population. The scope of practice issue will invariably be legislation that would expand the scope of various medical professionals’ practices. These will likely include the drugs that advanced nurse practitioners may prescribe and the services that dental hygienists may perform either with or without dentist supervision. There has been talk about the licensing of lay midwives.

The 2009 Legislative Session is building up to be a session of important health-related issues.