In 1953 the West Virginia Legislature created an advisory council to provide advice in the following three areas: 1) the Medical Services Fund, 2) disbursements from the Fund and 3) health and medical services. Medical expenses of Medicaid eligible clients are paid from the Medical Services Fund. Code of Federal Regulations 42, Section 431.12 requires that states form committees to advise Medicaid agencies, in West Virginia’s case the Bureau for Medical Services, about health and medical care services. In addition to State and Federal law, case law requires Medicaid officials to consult the Advisory Council before certain policies are adopted [Dunn v. Ginsberg, USDC, Southern District, WV]. The Council pre-existed Medicaid which was created as Title XIX of the Social Security Act of 1965. Without the Council the state would be in noncompliance with the State Medicaid Plan and federal Medicaid funds could be in jeopardy.

The name of the organization shall be the Medical Services Fund Advisory Council (hereinafter referred to as the Council) to the West Virginia Department of Health and Human Resources, Bureau for Medical Services (hereinafter referred to as the Department).

ARTICLE II - PURPOSE

The purpose of this Council shall be to consult with and advise the Department in developing and administering the State Medicaid Plan and health and medical care services.

ARTICLE III - MEMBERSHIP

Section I - Size and Representation of Membership

This Council shall consist of not less than nine (9) members nor more than thirteen (13), and must include:

1. A licensed physician in the field of medicine and surgery for whose appointment the State Medical Association and West Virginia Society of Osteopathic Medicine will make nomination of three qualified persons to the State Medicaid Agency.

2. A licensed dentist in the field of dentistry for whose appointment the State Dental Association will make nomination of three qualified persons to the State Medicaid Agency.

3. The Director of the Bureau of Public Health.

4. A member or members of consumers' groups, including Medicaid recipients, and consumer organizations such as labor unions, cooperatives, consumer-sponsored prepaid group practice plans, and others.

5. The remaining members shall be nominated by their respective state association by submitting three qualified persons to the State Medicaid Agency for each Association, and shall be from the fields of:

1) hospital organization and administration
2) pharmacy
3) nursing home administration
4) nursing
5) managed care organizations
6) other health organizations

ADHOC Committees or subcommittees of the Council will be approved by the Council and chaired by a council member or other person designated by the Council to consider and make recommendations to the Council regarding concerns of ancillary health providers as needed, and will continue to serve as determined by the Council.

Section II - Alternate Membership

Each member shall have an alternate member who must be a representative of the same provider or consumer group. The alternate shall be invited to all meetings. If both the member and alternate are in attendance, the alternate shall serve in an ex officio capacity. If only the alternate member is in attendance, he/she shall assume full membership status during that meeting. Members shall recommend to the State Agency/Commissioner this alternate.

Section III - Terms of Membership

The term of office of those members currently serving on the Advisory Council [January 1998], shall continue until they are reappointed or replaced in accordance with the provisions of this section.

Members shall be appointed by the single state agency on a rotating and continuous basis as required by 42 CFR 431.12(c). In order to establish a basis for staggered membership on the Medical Services Fund Advisory Council, all current members will be reappointed effective September 1, 1998. Five members will be appointed for a four (4) year term, four members will be appointed for a two (2) year term, and four members will be appointed for a one (1) year term. Thereafter, members who are appointed or reappointed to the Advisory Council will be appointed for a term of four (4) years, except that an appointment to fill a vacancy shall be for the unexpired term only.

Section IV - Resignations

A member of the Council may resign by written notice to the State Agency/ Commissioner with a copy to the Council Chairperson.

Section V - Removal

Any member of the Council may be removed by the State Agency/Commissioner for good cause. Good cause shall include, but not be limited to, the following:

A. Nonattendance - If a member and his/her alternate are absent from two consecutive meetings, their respective state associations will be asked to resubmit new names for reappointment.

B. Malfeasance or misfeasance in office.

ARTICLE IV - OFFICERS

The officers of the Council shall be a Chairperson and Vice Chairperson to be elected at the first meeting of each new calendar year by the Council membership. The officers will continue to serve until replaced.

ARTICLE V - MEETINGS

Meetings may be called at any time by the State Medicaid Agency, Council Chairperson, or upon the written request of any 3 members. Meetings are open to the public.

A simple majority of the membership of the Medical Services Fund Advisory Council will constitute a quorum.

ARTICLE VII - AMENDMENTS OF BY-LAWS

Amendment(s) of the by-laws may be made at any meeting of the Council by vote of two-thirds of the members present, provided that written notice of the proposed amendment(s) is sent to each member at least ten days prior to the meeting.