FISCAL NOTE

Date Requested: January 14, 2023 Time Requested: 02:59 PM

Agency: Public Employees Insurance Agency (PEIA) CBD Number: Version: Bill Number: Resolution Number: 1273 Introduced HB2086 CBD Subject:

FUND(S):

PEIA Basic Insurance Fund

Sources of Revenue:

Special Fund

Legislation creates:

Increases Existing Expenses

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Fiscal Note Summary

Effect this measure will have on costs and revenues of state government.

The purpose of this bill is to increase the number of pain management visits insurance companies must cover under the Opioid Reduction Act. The bill requires PEIA to cover 40 visits per event for each of the treatment modalities of physical therapy as an alternative to opioid drugs. PEIA currently requires prior authorization for any visit in excess of twenty therapies, with member paying deductible and coinsurance. The twenty-visit limit is cumulative for all therapies per event. PEIA currently charges a $20 copay for therapies under twenty-visits and a $25 copay for approved therapy over twenty-visits. This bill would limit the member out of pocket costs over the twenty-visit limit to a copay. PEIA currently pays $12,000,000 annually for combined therapies under twenty-visits. With consideration to doubling the twenty-visit limit, the loss of member deductible and coinsurance or a reduced copay for visits more than twenty, PEIA estimates cost exposure of $8,500,000 annually if the bill passes.

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Fiscal Note Detail

Effect of Proposal	Fiscal Year
	2023 Increase/Decrease (use"-")	2024 Increase/Decrease (use"-")	Fiscal Year (Upon Full Implementation)
1. Estmated Total Cost	0	0	8,500,000
Personal Services	0	0	0
Current Expenses	0	0	8,500,000
Repairs and Alterations	0	0	0
Assets	0	0	0
Other	0	0	0
2. Estimated Total Revenues	0	0	0

Explanation of above estimates (including long-range effect):

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Memorandum

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    Person submitting Fiscal Note: April Taylor
    Email Address: april.a.taylor@wv.gov