Current through Register Vol. XLI, No. 50, December 13, 2024
Section 64-70-2 - Definitions2.1. "Bureau for Medical Services" or "BMS" means the division within the West Virginia Department of Health and Human Resources (DHHR) that is responsible for administration of the Medicaid program in West Virginia.2.2. "Bureau for Public Health" or "BPH" means the division within DHHR that carries out the public health functions of DHHR.2.3. "Director" means the commissioner of BPH or his or her lawful designee.2.4. "Community-Based Board of Directors" means a board of directors composed of members who reside within the service area of the primary care center under consideration.2.5. "Federally Qualified Health Center (FQHC)" means an entity that meets the United States Health Care Financing Administration definition of a federally qualified health center promulgated at 42 CFR § 405.2401.2.6. "Federally Qualified Health Center Look-alike" or "Look-alike" means a public or not-for-profit health center that meets the eligibility requirements to receive a federal public health services grant under the "Public Health Services Act," 42 U.S.C. 254b, but does not receive grant funding.2.7. "Nonprofit" means an entity registered with the secretary of state as a nonprofit organization and is recognized as such for tax purposes or having filed an application for such designation.2.8. "Primary Care Center" means an organization which has as its purpose the delivery of primary care services.2.9. "Primary Care Service" means a health care service, including medical care, that emphasizes first-contact patient care and assumes overall and ongoing responsibility for the patient in both health maintenance and treatment of illness. Primary care involves a unique interaction between the patient and primary care physician or a multi-disciplinary team under the supervision of a physician or both. The appropriate use of referrals and community resources is an important part of effective primary care. The care is generally provided by a physician but may be provided by other members of a multi-disciplinary team such as registered nurses, nurse practitioners, physician assistants, and nurse-midwives. The purpose of this interaction is to achieve comprehensive coordination of health care including educational, behavioral, biological, and social aspects of care. It is a patient care-oriented approach which emphasizes the continuity of care over the full spectrum of health services. It begins with patient assessment, wellness, and prevention through medical management, lifestyle modification, and health education. The primary care provider is the patient's advocate through the complex system of health care delivery.2.10. "Program" means the Primary Care Support Program within BPH.2.11. "Related Organization" means any organization, whether publicly owned, nonprofit tax-exempt, or for profit, related to a primary care center through common membership, governing bodies, trustees, officers, stock ownership, family members, partners, or limited partners, or a subsidiary, foundation, related corporation, joint venture, or other similar organization, if such similar organization controls or is controlled by the primary care center through contracts, or other legal documents that allow the organization the authority to direct any of the primary care center's activities, management, or policies. A subsidiary, foundation, related corporation, joint venture, or other similar organization shall also be considered a "related organization" in the following situations: 2.11.1. The subsidiary, foundation, related corporation, joint venture or other similar organization has solicited funds in the name of the primary care center with the express or implied approval of the primary care center, and any portion of the funds were intended by the contributor, or otherwise required to be used, for the benefit of the primary care center;2.11.2. The primary care center has transferred or may transfer resources to the subsidiary, foundation, related corporation, joint venture, or other similar organization;2.11.3. The subsidiary, foundation, related corporation, joint venture, or other similar organization has transferred or may transfer resources to the primary care center, or any of the primary care center's resources are held for the benefit of the subsidiary, foundation, related corporation, joint venture, or other similar organization;2.11.4. The primary care center has assigned certain of its functions to the subsidiary, foundation, related corporation, joint venture, or other similar organization, that is operating primarily for the benefit of the primary care center;2.11.5. The subsidiary, foundation, related corporation, joint venture, or other similar organization is wholly owned or was created by the primary care center, and the primary care center receives any of the profits of the subsidiary, foundation, related corporation, joint venture, or other similar organization; or2.11.6. The primary care center is wholly owned or was created by the foundation, related corporation, joint venture, or other similar organization, and the foundation, related corporation, joint venture, or other similar organization receives any of the revenues of the primary care center.2.12. "Rural Health Clinic" or "RHC" means a facility that: 2.12.1. Has been determined by the Secretary of the United States Department of Health and Human Services to meet the requirements of section 1861(aa)(2) of the United States Social Security Act, Title 42 U.S.C. § 1395x(aa)(2), and for certification for participation in Medicare; and2.12.2. Has filed an agreement with the Secretary of the United States Department of Health and Human Services in order to provide rural health clinic services under Medicare. (See 42 CFR Part 405, Subpart X and 42 CFR Part 491 for additional information.)2.13. "Secretary" means the Secretary of the Department of Health and Human Resources.2.14. "Sliding Fee Scale" means a set of varying amounts (percentages of a maximum fee) to be charged for services to individuals receiving varying levels of income.2.15. "Uncompensated Primary Care Costs" means a primary care center's financial deficit created when the primary care center's revenues do not offset expenses incurred in rendering primary care services.