West Virginia Code of State Rules Agency 72 - Catastrophic Illness Commission
Here's an enhanced and structured overview of West Virginia Code of State Rules — Agency 72: Catastrophic Illness Commission (Title 72):
🏛️ Agency 72 – Catastrophic Illness Commission
Established under W. Va. Code §16-5Q, the Commission administers the James “Tiger” Morton Catastrophic Illness Fund, providing financial assistance to West Virginians facing life-threatening medical conditions who have exhausted all other resources.(apps.sos.wv.gov)
📘 Title 72 – Legislative Rule: Eligibility Standards
Series 72-01 – Eligibility Standards for Economic Assistance from James “Tiger” Morton Catastrophic Illness Fund
Effective since May 7, 2004 .(law.cornell.edu)
🧾 Key Provisions of Series 72-01
Eligibility Criteria (§72-1-5)
Residency: Applicant must be a West Virginia resident for at least one year prior to diagnosis.
Catastrophic Illness Definition: Condition must pose an imminent risk of death if assistance is not provided.
Exhaustion of Resources: Applicant must have exhausted all other resources, including Medicaid and Hill-Burton funds.
Medicaid Requirement: Applicant must apply for and be denied Medicaid, except in specific situations.(wvdhhr.org)
Application Process (§72-1-4)
Applications are accepted directly from potential clients; involvement from medical facilities is encouraged.
Applications can be initiated by calling the Commission at 304-558-9027.
A decision is typically made within one week of application .(wvdhhr.org)
Approved Care and Services (§72-1-6)
Payments are made directly to medical providers for services covered under the Medicaid program.
Travel reimbursements are made to third-party providers.
All services must be preauthorized by the Commission.(wvdhhr.org)
Disapproved Care and Services (§72-1-7)
Certain services may not be covered, including elective procedures or those not deemed medically necessary.
Specific exclusions are detailed within the rule.
Determination of Eligibility and Award (§72-1-8)
The Commission reviews applications and determines eligibility based on established criteria.
Awards are made based on available funds and the urgency of the medical condition.(wvdhhr.org)
Confidentiality and Records (§72-1-9)
All applicant information is kept confidential in accordance with state and federal privacy laws.
Records are maintained securely and are accessible only to authorized personnel.
Administrative Due Process (§72-1-10)
Applicants have the right to appeal decisions made by the Commission.
The rule outlines the process for filing appeals and the procedures for hearings.
🧑⚖️ Commission Structure and Operations
Composition: The Commission consists of six members appointed by the Governor, including a medical doctor, an attorney, a nurse, a social worker, and two public members active in community affairs.
Meetings: The Commission meets at least quarterly and may call special meetings as needed.
Executive Director: Appointed by the Commission, the Executive Director administers the affairs of the Commission and carries out its decisions.
Annual Recommendations: The Commission submits an annual recommendation to the Legislature regarding appropriations from the Catastrophic Illness Fund .(codes.findlaw.com)
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