§9-5-27. Transitioning foster care into managed care.
(a) “Eligible services” means acute care, including medical, pharmacy, dental, and behavioral health services.
(b) The secretary shall transition to a capitated Medicaid program for a child classified as a foster child and a child placed in foster care under Title IV-E of the Social Security Act who is living in the state by January 1, 2020. The program shall be statewide, fully integrated, and risk based; shall integrate Medicaid-reimbursed eligible services; and shall align incentives to ensure the appropriate care is delivered in the most appropriate place and time.
(c) The secretary shall make payments for the eligible services, including home and community-based services, using a managed care model.
(d) The secretary shall submit, if necessary, applications to the United States Department of Health and Human Services for waivers of federal Medicaid requirements that would otherwise be violated in the implementation of the program and shall consolidate any additional waivers where appropriate: Provided, That this subsection does not apply to the Aged and Disabled Waiver, the Intellectual/Developmental Disabilities Waiver, and the Traumatic Brain Injury Waiver.
(e) If a selected managed care organization ceases to contract to provide Medicaid managed care services, it must provide all patient records, including medical records, to the next selected managed care organization to ensure the Eligible Medicaid Beneficiaries do not experience an interruption in care.
(f) In designing the program, the secretary shall ensure that the program:
(1) Reduces fragmentation and offers a seamless approach to meeting participants’ needs;
(2) Delivers needed supports and services in the most integrated, appropriate, and cost-effective way possible;
(3) Offers a continuum of acute care services, which includes an array of home and community-based options; and
(4) Includes a comprehensive quality approach across the entire continuum of care services.
(g) An employee of the department who, as a function of that employment, has engaged in the development of any contract developed pursuant to the requirements of this section may not for a period of two years thereafter be employed by any agency or company that has benefitted or stands to benefit directly from a contract between the department and that agency or company.
(h) Any managed care company selected as the managed care contractor pursuant to the provisions of this article shall have at least 80 percent of the total full-time equivalent positions allocated to manage care of foster children in West Virginia according to the contract must have a primary workplace in the state of West Virginia.
