West Virginia Code 5-16B-5 – Director of the Children’s Health Insurance Program; qualifications; powers and duties
(a) The commissioner shall appoint an individual in the classified service as a deputy commissioner to serve as the director who shall be responsible for the implementation, administration, and management of the Children’s Health Insurance Program created under this article. The director shall have at least a bachelor’s degree and a minimum of three years’ experience in health insurance administration.
Terms Used In West Virginia Code 5-16B-5
- Agency: means the Children's Health Insurance Agency, a division within the Bureau for Medical Services. See West Virginia Code 5-16B-2
- Board: means the Children's Health Insurance Program Advisory Board. See West Virginia Code 5-16B-2
- Commissioner: means the Commissioner of the Bureau for Medical Services appointed by the Secretary of the Department of Health and Human Resources. See West Virginia Code 5-16B-2
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Director: means the deputy commissioner within the Bureau for Medical Services who has responsibility for the operation and oversight of the Children's Health Insurance Agency. See West Virginia Code 5-16B-2
- Program: means the West Virginia Children's Health Insurance Program. See West Virginia Code 5-16B-2
(b) The director shall employ any administrative, technical, and clerical employees that are required for the proper administration of the program and for the work of the board.
(c) The director is responsible for the administration and management of the program and may make all rules necessary to effectuate the provisions of this article. Nothing in this article may be construed as limiting the director’s otherwise lawful authority to manage the program on a day-to-day basis.
(d) The director may execute any contracts that are necessary to effectuate the provisions of this article. The provisions of § 5A-3-1 et seq. of this code, relating to the division of purchasing of the department of finance and administration, may not apply to any contracts for any health insurance coverage, health services, or professional services authorized to be executed under the provisions of this article: Provided, That before entering into any contract, the director shall invite competitive bids from all qualified entities and shall deal directly with those entities in presenting specifications and receiving quotations for bid purposes. The director shall award those contracts on a competitive basis taking into account the experience of the offering agency, corporation, insurance company, or service organization. Before any proposal to provide benefits or coverage under the plan is selected, the offering agency, corporation, insurance company, or service organization shall provide assurances of utilization of essential community health service providers to the greatest extent practicable. In evaluating these factors, the director may employ the services of independent, professional consultants. The director shall then award the contracts on a competitive basis.
(e) The director shall issue requests for proposals on a regional or statewide basis from essential community health service providers for defined portions of services under the children’s health insurance plan and shall, to the greatest extent practicable, either contract directly with, or require participating providers to contract with, essential community health service providers to provide the services under the plan.
(f) The director may require reinsurance of primary contracts, as contemplated in the provisions of §33-4-15 and § 33-4-15a of this code.