SENATE CONCURRENT RESOLUTION NO. 30
(By Senators Tomblin, Mr. President, Plymale,
Walker, Craigo, Jackson, Anderson, Bailey, Ball, Boley, Bowman,
Chafin, Dittmar, Edgell, Fanning, Helmick, Hunter, Kessler, Love,
McCabe, McKenzie, Minard, Minear, Mitchell, Oliverio, Prezioso,
Redd, Ross, Schoonover, Sharpe, Snyder, Sprouse, Unger and
Wooton)
Requesting the President of the Senate and the Speaker of the House
of Delegates to appoint a task force to conduct a study of the
Public Employees Insurance Agency health plan and to review
the effects of changes in benefits and provider reimbursement.
Whereas, Benefits from the Public Employees Insurance Agency
health plan are paid to approximately two hundred thousand West
Virginia citizens each year, including thirty thousand employees of
state agencies, thirty-three thousand employees of county boards of
education, twenty-five thousand retirees and seven thousand
employees of other political subdivisions within the state, as well
as the dependents of these policyholders; and
Whereas, Access to quality health care at affordable rates is
a reasonable expectation of the workers covered by the Public
Employees Insurance Agency health plan and it is a reasonable
expectation of all citizens of West Virginia; and
Whereas, There is a critical need to develop methods which will assure the availability of all necessary medical care and
hospitalization for the policyholders of the Public Employees
Insurance Agency health plan at costs that can be reasonably borne
by the plan and the enrolleres; and
Whereas, The Legislature is desirous of developing a long- lasting solution to the problems of rising health care costs within
the Public Employees Insurance Agency health plan and within the
state as a whole; and
Whereas, The Legislature is desirous of implementing effective
programs that will support the health care needs of all West
Virginians and which will promote the practice of appropriate medical care
within the state; and
Whereas, The Legislature recognizes the need to call upon all
entities of the Public Employees Insurance Agency in order to
develop a permanent and acceptable solution to the problems of
rising health care costs; therefore, be it
Resolved by the Legislature of West Virginia:
That the Legislature hereby requests the President of the
Senate and the Speaker of the House of Delegates to appoint a task
force to conduct a study of the Public Employees Insurance Agency health plan and to review the effects of changes in benefits and
provider reimbursement; and, be it
Further Resolved, That the task force shall include members of
the Senate and House of Delegates appointed by the President of the
Senate and the Speaker of the House of Delegates, respectively;
and, be it
Further Resolved, That the task force should also include
representatives of each of the employee unions that are covered by
the Public Employees Insurance Agency health plan in order to
assure that the employees have a role in developing solutions to
the problems experienced by the health plan; and, be it
Further Resolved, That the task force shall be directed to
review, examine and study the Public Employees Insurance Agency and
to develop recommendations to the Legislature as to policies,
programs and practices which may be instituted, including: (a) To
guarantee the continuation of an affordable health plan that
assures access to all necessary medical care; (b) to educate
policyholders of the Public Employees Insurance Agency health plan
of the issues affecting the cost of the plan and their continued
access to quality health care with the goal of encouraging cost
effective utilization of the health program; (c) to promote the use of in-state health providers and providers who participate in cost
effectiveness of the preferred provider network framework that was
incorporated into the indemnity benefit plan; (d) to examine the
feasibility and cost effectiveness of the preferred provider
network framework that was incorporated into the indemnity benefit
plan; (e) to study the impact of changing the benefit structure and
increasing out-of-pocket costs under the terms of the indemnity
benefit plan; (f) to research the restructuring of the prescription
drug program, including the increase in out-of-pocket costs,
the
implementation of a drug formulary and other plan modifications,
and assess the projected costs savings, and to determine alternative
plan changes; (g) to examine the potential cost impact and health
outcomes associated with the introduction of preventive care and
wellness programs in conjunction with the indemnity plan; (h) to
investigate the feasibility and cost implications of establishing
a health maintenance organization for policyholders of the Public
Employees Insurance Agency; (i) to assess the feasibility of the
state medical schools actively participating in managed care
options for Public Employees Insurance Agency policy holders and
their dependants; (j) to review the cost and utilization statistics
of various elements of the Public Employee Insurance Agency health
plan, including emergency room usage, psychiatric and mental health care, prescription drugs, retiree health benefits;, and out-of-state
usage, in order to examine alternative processes that will serve to
hold costs down while not hindering access to necessary care; (k)
to study other options for holding costs down and providing
incentives to health care consumers and providers to practice
appropriation care, including providing rewards to policyholders
who report provider overbilling and interviewing providers whose
cost and utilization profiles are consistently outside the normal
patterns of practice; and, be it
Further Resolved, That the task force shall study
administrative processes and procedures of the Public Employees
Insurance Agency to assure that information and computer systems
are providing adequate and accurate support to the agency in terms
of enrollment and data reporting, and make recommendations for
updating such systems, and to assure that claims processing, including
collection of coinsurance due from other carriers, is expeditious
and accurate; and, be it
Further Resolved, That the task force shall be directed to
study the financial impact of all recommendations and proposed
changes upon the current and future cost of the Public Employees
Insurance Agency and to determine whether enough savings will be generated to adequately fund the health program for the future;
and, be it
Further Resolved, That the task force shall have authorization
from the Legislature to call upon representatives of other health
care purchasers within the state and other health care consumer
representatives in order to learn their experience with the state's
health care delivery system and to determine the feasibility of
developing purchasing coalitions with private sector health care
purchasers as a method for keeping health costs down; and, be it
Further Resolved, That the task force report to the regular
session of the Legislature by January 1, 2000, on its findings,
conclusions and recommendations, together with drafts of any
legislation necessary to effectuate its recommendations; and, be it
Further Resolved, That the expenses necessary to conduct the
duties of the task force, to prepare a report and to draft
necessary legislation be paid from legislative appropriations to
the Joint Committee on Government and Finance.