West Virginia SB 591: Increasing reimbursement rate for certain Medicaid services

Bill Text

SB 591 Text

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Introduced Version

« Senate Bill 591 History

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 Key: Green = existing Code. Red = new code to be enacted

WEST virginia legislature

2018 regular session

Introduced

Senate Bill 591

By 
Senator Drennan

[Introduced February 19, 
2018; Referred

to the Committee on Health and Human Resources; and then to the Committee on 
Finance]

A BILL to amend the Code 
of West Virginia, 1931, as amended, by adding thereto a new section, designated 
§9-5-27, relating to increasing the reimbursement rate for certain Medicaid 
services; setting forth requirements; requiring records be kept; and permitting 
waiver amendments be filed. 

Be it enacted by the 
Legislature of West Virginia:

ARTICLE 5. MISCELLANEOUS 
PROVISIONS.

§9-5-27. Increasing 
the reimbursement rate for certain services.

(a) The definitions set 
forth in §9-1-2 of this code apply to the terms that are used in this section. 

(b) The commissioner 
shall increase the reimbursement rate for services if the services are provided 
as follows: 

(1) The services are 
provided to an individual who receives services under a Medicaid waiver under 
the federal Home and Community Based Services Program. 

(2) The individual is 
authorized under the Medicaid waiver described in subdivision (1) of this 
subsection to receive any of the following services: 

(A) Adult day services; 

(B) Prevocational 
services; 

(C) Residential 
habilitation and support; 

(D) Respite; 

(E) Supported employment 
and extended services as defined in the family supports Medicaid waiver; 

(F) Community 
habilitation and participation services; 

(G) Workplace 
assistance, as defined in the family supports Medicaid waiver and the community 
integration habilitation Medicaid waiver; 

(H) Facility 
habilitation; 

(I) Residential habilitation 
and support; 

(J) Transportation 
services; 

(K) Participant 
assistance and care, as defined in the family supports Medicaid waiver; and 

(L) Facility based 
support, as defined in the family supports Medicaid waiver and the community 
integration habilitation Medicaid waiver. 

(3) The services are 
delivered to the individual by a direct care staff. 

(c) The amount of the 
increase in the reimbursement rate described in subsection (b) of this section for 
the fiscal year beginning July 1, 2018, and thereafter, is the reimbursement rate 
in effect as of June 30, 2018, for the services listed in subdivision (2), subsection 
(b) of this section multiplied by 5 percent. 

(d) An authorized 
service provider shall use at least 75 percent of the amount of the increase in 
the reimbursement rate to increase the wages paid to direct care staff who: 

(1) Are employed by the 
authorized service provider to provide services in West Virginia; and 

(2) Provide support 
services listed in subdivision (2), subsection (b) of this section.

(e) If a provider does 
not use at least 75 percent of the increase to increase wages paid to direct 
care staff, the department shall recoup part or all of the increase in the 
reimbursement rate that the provider receives as provided in subsection (g) of 
this section. 

(f) An authorized 
service provider providing services in West Virginia shall provide written and 
electronic notification of its plan to increase wages to: 

(1) Direct care staff 
employed by the provider; and 

(2) The commissioner 
within 30 days after the department implements an increase in reimbursement 
rates. 

(g) The department may 
recoup the difference between 75 percent of the amount received by a provider 
as a result of increased reimbursement rates and the amount of the increase 
that is actually used by the provider to pay an increase in wages to direct 
care staff. The remaining 25 percent may be retained by the provider to cover 
the other employer-related costs of providing direct care services, including 
payroll taxes, b