State Codes and Statutes

State Codes and Statutes

Statutes > West-virginia > 16 > 16-1a-5

§16-1A-5. Development of legislation regarding CVO; report required.
(a) On or before January 1, 2010, the advisory committee established pursuant to section four of this article shall develop legislation that considers the following:

(1) The establishment of one or more CVOs within the state to provide primary source verification with electronic accessibility on a cost effective and operationally efficient basis;

(2) The number of CVOs necessary to provide this access for the state;

(3) The treatment of existing CVOs currently doing business within the state;

(4) The duties of a CVO and the timelines for completion of its verification duties;

(5) The procedures for maintaining healthcare practitioner files;

(6) The payment system to cover the costs of the credentialing program;

(7) The use and confidentiality of data generated, collected and maintained by a CVO;

(8) Compliance by CVOs with certificate requirements including NCQA, URAC, Medicare and Medicaid and other state and federal requirements;

(9) The required use by payors and hospitals of a CVO's primary source verification services;

(10) Credentialing recredentialing requirements as required by payors, hospitals and state and federal law and regulations;

(11) The use of site visits in credentialing;

(12) The maintenance, amounts and types of liability insurance to be obtained by a CVO;

(13) Consideration of existing statutory protections that should be extended to the CVO;

(14) Privacy considerations;

(15) If applicable, the terms and conditions of the contract under which a CVO operates in this state and the procedure and criteria upon which a CVO is selected;

(16) Penalties, if any, for noncompliance;

(17) Timelines for credentialing, recredentialing and other compliance obligation of payors;

(18) Reconciliation of the use of forms required by this article with other applicable state and federal laws and regulations.

(b) On or before January 1, 2010, the department and the commissioner shall jointly report to the Legislative Oversight Commission on Health and Human Resources Accountability proposed legislation to implement the provisions set forth in this article.