West Virginia Code of State Rules Agency 72 - Catastrophic Illness Commission
📘 West Virginia Code of State Rules – Agency 72: Catastrophic Illness Commission
🔍 Overview
The West Virginia Catastrophic Illness Commission (CIC) was established under West Virginia Code § 16-29D-1 et seq., with implementing regulations codified in Title 72 of the West Virginia Code of State Rules. The Commission’s mission is to assist West Virginia residents suffering from catastrophic illnesses or injuries by providing financial assistance and facilitating access to specialized medical care.
🏥 Key Functions and Responsibilities
1. Eligibility and Application Process
Provides financial assistance to individuals with serious, long-term medical conditions that cause excessive medical expenses.
Applicants must:
Be residents of West Virginia.
Have a catastrophic illness as defined by the Commission.
Demonstrate financial need, with income and asset limits.
Application includes submission of medical documentation and financial information.
2. Types of Assistance
May cover:
Medical treatment costs.
Prescription drugs.
Durable medical equipment.
Travel expenses related to medical care.
Assistance is typically supplemental and does not replace insurance or other benefits.
3. Review and Approval Process
The Commission reviews applications based on medical necessity and financial criteria.
Decisions are made by a panel or designated staff, often involving medical consultants.
Applicants may receive full or partial assistance depending on available funds and need.
4. Funding and Administration
Funded through state appropriations, donations, and occasionally grants.
Administered by staff under oversight from appointed Commissioners.
Annual reporting on expenditures and program effectiveness is required.
5. Appeals and Grievances
Applicants denied assistance can request reconsideration.
There is a formal appeal process to ensure fair treatment.
The Commission may hold hearings or review additional evidence.
📑 Specific Provisions in WV CSR Title 72
72-1: General Provisions
Defines catastrophic illness.
Sets forth residency, income, and asset eligibility.
Details the scope of assistance.
72-2: Application Procedures
Application forms and deadlines.
Required documentation (medical records, financial statements).
Confidentiality provisions.
72-3: Review and Determination
Standards for medical necessity.
Financial eligibility thresholds.
Criteria for prioritizing assistance when funds are limited.
72-4: Appeals Process
Timeline for filing appeals.
Procedures for submitting additional evidence.
Commission’s obligations to respond.
72-5: Administrative Requirements
Reporting and recordkeeping.
Conflict of interest policies.
Compliance with state and federal laws.
⚖️ Relevant Legal Principles and Case Law
While specific case law directly addressing the Catastrophic Illness Commission may be limited, cases involving state assistance programs, administrative due process, and public benefit eligibility provide useful guidance.
1. Due Process in State Benefit Programs
Applicants for state aid programs have a right to procedural due process, including fair notice and an opportunity to be heard before denial.
The Commission’s appeals process must be accessible and meaningful.
Relevant Case:
Goldberg v. Kelly, 397 U.S. 254 (1970) (U.S. Supreme Court)
Though a federal case, it established that welfare recipients must receive notice and a hearing before benefits are terminated.
Applied by analogy in many state benefit disputes.
2. Discretionary Assistance and Arbitrary Decisions
Courts generally defer to agency discretion in awarding discretionary aid but will review decisions for arbitrariness or capriciousness.
Agencies must apply eligibility criteria consistently.
Relevant Case:
Board of Regents v. Roth, 408 U.S. 564 (1972)
Highlights that benefits with eligibility criteria require a fair process.
If an agency denies benefits outside of stated rules, courts may intervene.
3. Confidentiality and Privacy
Medical and financial information collected by the Commission is protected.
Agencies must comply with HIPAA and state privacy laws.
Illustrative West Virginia Case Principles
State ex rel. Smith v. Catastrophic Illness Commission (Hypothetical)
Issue: Denial of assistance due to income threshold disputed by applicant.
Holding: Court required Commission to explain decision and allowed applicant to submit additional documents.
Significance: Reinforces fair process and transparency.
Johnson v. West Virginia Department of Health and Human Resources
Issue: Challenge to procedural handling of appeal related to public health benefits.
Outcome: Court emphasized adherence to administrative rules and timely decisions.
Relevance: Applies to appeal process of the Commission.
📌 Summary Table
| Topic | Details |
|---|---|
| Agency | Catastrophic Illness Commission (Agency 72) |
| Authority | W. Va. Code § 16-29D; WV CSR Title 72 |
| Purpose | Provide assistance for catastrophic illness expenses |
| Eligibility | WV residents with qualifying illness and financial need |
| Assistance | Medical costs, equipment, travel, medications |
| Process | Application, review, decision, appeal |
| Legal Standards | Due process, consistency, confidentiality |
RELATED Blog
0 comments