Chapter 5, Chapter 5

The director may negotiate and execute pharmacy benefit management contracts for the purpose of managing rising drug costs for this state and all parties which have executed prescription drug purchasing agreements with the director.

(a) Benefit plan design. — All financial plans required by this section shall establish: (1) the design of a benefit plan or plans; (2) the maximum levels of reimbursement to categories of health care providers; (3) any cost containment measures for implementation during the appl…

Health insurance provided by the program, including coverage provided through a contract with a managed care corporation, shall include coverage of: (i) The patient cost of clinical trials, to the same extent as such coverage is mandated for the public employees insurance program…

(a) Upon approval by the Centers for Medicare and Medicaid Services, the agency shall implement a benefit plan for uninsured children of families with income between 200 and 300 percent of the federal poverty level. (b) The benefit plans offered pursuant to this section shall inc…

(a) There is hereby created in the state Treasury a special revolving fund to be known as the "West Virginia children's health fund", which shall be an interest-bearing account. All moneys deposited or accrued in this fund shall be used exclusively: (1) To provide the state's sha…

The provisions of article three, chapter five-a of this code do not apply to the agreements and contracts executed under the provisions of this article, except that the contracts and agreements shall be approved as to form and conformity with applicable law by the Attorney Genera…

(a) The agency shall establish plans for those employees herein made eligible and establish and promulgate rules for the administration of these plans subject to the limitations contained in this article. These plans shall include: (1) Coverages and benefits for x-ray and laborat…

(a) Pursuant to the authority contained in section one, article one, chapter four of this code, the presiding officers of each house of the Legislature may appoint a joint committee to be known at the Select Committee on Other Post-Employment Benefits to study other post-employme…

(a) Notwithstanding any provision of any policy, provision, contract, plan or agreement applicable to this article, reimbursement or indemnification for colorectal cancer examinations and laboratory testing may not be denied for any nonsymptomatic person fifty years of age or old…

(a) The plan shall provide coverage of health care services provided through telehealth services if those same services are covered through face-to-face consultation by the policy. (b) The plan may not exclude a service for coverage solely because the service is provided through …

(a) The plan shall provide, in a case of a participant or beneficiary who is receiving benefits in connection with a mastectomy and who elects breast reconstruction in connection with such mastectomy, coverage for: (1) All stages of reconstruction of the breast on which the maste…

(a) The provisions of this section and section seven-e of this article apply to the health plans regulated by this article. (b) This section does not apply to a policy, plan or contract paid for under Title XVIII of the Social Security Act. (c) A policy, plan or contract subject …

For purposes of section seven-d of this article: (a) A "clinical trial" is a study that determines whether new drugs, treatments or medical procedures are safe and effective on humans. To determine the efficacy of experimental drugs, treatments or procedures, a study is conducted…

(a) As used in this section, the following words and phrases have the meanings given to them in this section unless the context clearly indicates otherwise: "Episode of care" means a specific medical problem, condition, or specific illness being managed, including tests, procedur…

(a) A policy, plan, or contract that is issued or renewed on or after January 1, 2024, shall provide coverage for prescription insulin drugs and equipment to this section. (b) Cost sharing for a 30-day supply of a covered prescription insulin drug may not exceed $35 in aggregate,…

(a) For purposes of this section: "Covered treatment" means a service, procedure, therapy, medication, or course of care covered under an agency health plan. "Alternative treatment" means a different covered treatment for the same diagnosed condition or illness that is medically …

(a) The director shall cause to be conducted an audit of any funds expended pursuant to any prescription drug purchasing agreement or pharmacy benefit management contract executed under the provisions of this article for each fiscal year that the prescription drug purchasing agre…

The program established in this article abrogates and and has no further force and effect, without further action by the Legislature, upon the occurrence of any of the following: (a) The date of entry of a final judgment or order by a court of competent jurisdiction which disallo…

The insurance plans provided for in this article shall be designed by the Public Employees Insurance Agency: (1) To provide a reasonable relationship between the hospital, surgical, medical, and prescription drug benefits to be included and the expected reasonable and customary h…

(a) The plan shall reimburse any air-ambulance provider that provides emergency air transportation or related emergency medical or treatment services to an employee or dependent of an employee covered by the plan the amount then in effect for the federal Medicare program, includi…

(a) For the purpose of this section, "scalp cooling system" means any device used to cool the human scalp to prevent or reduce hair loss during cancer chemotherapy treatment, provided that such device is designed and intended for repeated use and is primarily and customarily used…

The director may work in conjunction with a nonprofit corporation organized pursuant to the corporate laws of the state, structured to permit qualification pursuant to section 501(c) of the Internal Revenue Code for purposes of assisting the children’s health program and funded f…

(a) The director may explore innovative strategies by which West Virginia may manage the increasing costs of prescription drugs and increase access to prescription drugs for all of the state's citizens, including: (1) Enacting fair prescription drug pricing policies; (2) Providin…

(a) The director is given exclusive authorization to execute such contract or contracts as are necessary to carry out the provisions of this article. (b) The provisions of §5A-3-1 et seq. of this code, relating to the Division of Purchasing of the Department of Finance and Admini…

Unless the context in which used clearly requires a different meaning, as used in this article: "Public agency" means the State of West Virginia, counties, municipalities, towns, boards of education, public service districts and other political subdivisions of this state. "Public…

(a) Every state spending unit, as defined in chapter five-a, shall require that every contract or subcontract for the construction, reconstruction, alteration, repair, improvement or maintenance of public works or for the purchase of any item of machinery or equipment to be used …

A public agency may not authorize or make any payments to a contractor under a contract which contains or should contain the provision required by section two of this article unless such contractor has fully complied with such provision. Prior to such payment, the public agency s…

If prior to the award of a contract under this article, the spending officer, as defined in chapter five-a, determines that there exists a bid or offered price of like aluminum, glass or steel products of foreign origin that is reasonable and lower than the lowest bid or offered …

As used in this article: (a) "ASHRAE" means the organization known as the American Society of Heating, Refrigerating and Air Conditioning Engineers. (b) "Director" means the director of the Governor's office of economic and community development.

The director shall develop statewide energy cost reduction guidelines to be applicable to new and significantly renovated buildings for which a building permit is issued. In developing the guidelines, the director shall establish as the minimum criterion the ASHRAE 90-75 standard…

To assist in the development and implementation of statewide energy guidelines under this article, the director shall appoint an advisory commission of seven members who shall serve without compensation. In appointing the commission, the director shall include representatives of …

The following shall be exempt from compliance with the energy cost reduction guidelines developed under this article: (a) Any type or class of building specifically made exempt by the local jurisdiction; (b) Mobile homes; (c) Any structure neither heated nor cooled, nor designed …

The provisions of this article shall not apply to any application for a building permit made before January 1, 1981.

(a) This section and the requirements in this section may be referred to as the West Virginia Fairness in Competitive Bidding Act. (b) As used in this section: (1) "Alternates" means any additive options or alternative designs included in a solicitation for competitive bids that …

This article shall be known and may be cited as the "West Virginia Design-Build Procurement Act." The provisions of this article must be used to select design-builders for authorized projects that are constructed and owned, potentially owned, or ultimately owned by any agency.

This act shall be known as the Government Construction Management At-Risk Contracts Act. The provisions of this article may be used to select construction managers at-risk for authorized public construction projects as set forth in this article. Notwithstanding the provisions of …

(a) The agency shall prepare an invitation for proposals for the qualified design-builders, which must provide at a minimum: (1) The identity of the agency which will award the design-build contract; (2) The procedures to be followed for submitting proposals, the criteria for eva…

(a) The evaluation committee shall interview each prequalified firm that submits a proposal. The purpose of the interview is to allow each prequalified firm an opportunity to clarify and respond to questions related to its proposal. The state and/or its subdivisions may provide a…

(a) Proposals shall be submitted in two separate, clearly identified, sealed packages, with the first containing the technical submission and the second containing the cost submission. If the technical submission and cost submission are not submitted in two separate, clearly iden…

(a) The state and/or its subdivisions shall evaluate proposals for a construction management at-risk contract in accordance with the provisions of this article. (b) The state and/or its subdivisions shall evaluate and rank each proposal on the basis of best meeting the criteria i…

(a) The design-builder shall submit the proposal to the agency as required in the invitation for proposals. Clarifications may be required to ensure conformance of proposals with the performance criteria. In seeking clarifications, the performance criteria developer may not revea…

(a) The evaluation committee shall evaluate proposals taking into consideration the criteria set out in this section with the maximum percentage of total points for evaluation which may be assigned to each criterion as set forth in this section. The following criteria shall be ev…

The performance criteria developer must visit the site at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work completed and to determine in general if the work is being performed in a manner indicating that wor…

A construction management at-risk contract may be conditioned upon later refinements in scope and price and may permit the state and/or its subdivisions in agreement with the construction manager to make changes in the project without invalidating the contract. Later refinements …

At the option of the design-builder, proposals may be withdrawn for any reason at any time prior to their opening without forfeiture of the security. Once opened, a proposal may be withdrawn for any reason prior to acceptance with forfeiture of the bid bond.

(a) Records that are maintained by the state and/or its subdivisions during the qualifications phase and proposal phase are public, to the extent permitted by §29B-1-1 et seq. of this code, and shall be available for inspection only after the announcement of the state and/or its …

Nothing contained within the provisions of this article shall be construed to limit or reduce existing statutory or regulatory requirements regarding bonding or insurance.

The provisions of subsection (cc), section ten, article two, chapter two of this code shall apply to the provisions of this chapter to the same extent as if the same were set forth in extension herein.

(a) The state and/or its subdivisions shall not use a construction management at-risk contract for a construction project with locations on parcels of land which are not contiguous except for specialty maintenance projects. (b) For purposes of this section: (1) A specialty mainte…

The Division of Purchasing shall propose rules for legislative approval in accordance with the procedures of §29A-3-1 et seq. of this code to develop standardized forms for use in construction management at-risk contracting. These forms shall include: (1) An offeror required info…