Introduced Version
House Bill 2877 History
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Key: Green = existing Code. Red = new code to be enacted
H. B. 2877
(By Delegates White, Eldridge, Ferns, Marshall,
Perry, Marcum and Moore)
(By Request of the Department of Administration)
[Introduced March 8, 2013; referred to the
Committee on Health and Human Resources then Finance.]
A BILL to amend and reenact §5-16-3 of the Code of West Virginia,
1931, as amended, relating to permitting the Director of the
Public Employees Insurance Agency to operate any of the
agency's health benefits plans on a calendar year if it is
financially advantageous; and providing that financial plans
shall continue to be on a fiscal year basis.
Be it enacted by the Legislature of West Virginia:
That §5-16-3 of the Code of West Virginia, 1931, as amended,
be amended and reenacted to read as follows:
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-3. Composition of Public Employees Insurance Agency;
appointment, qualification, compensation and duties
of Director of Agency; employees; civil service
coverage.
(a) The Public Employees Insurance Agency consists of the director, the Finance Board, the Advisory Board and any employees
who may be authorized by law. The director shall be appointed by
the Governor, with the advice and consent of the Senate, and serves
at the will and pleasure of the Governor. The director shall have
at least three years' experience in health or governmental health
benefit administration as his or her primary employment duty prior
to appointment as director. The director shall receive actual
expenses incurred in the performance of official business. The
director shall employ any administrative, technical and clerical
employees required for the proper administration of the programs
provided in this article. The director shall perform the duties
that are required of him or her under the provisions of this
article and is the Chief Administrative Officer of the Public
Employees Insurance Agency. The director may employ a deputy
director.
(b) Except for the director, his or her personal secretary,
the Deputy Director and the Chief Financial Officer, all positions
in the agency shall be included in the classified service of the
civil service system pursuant to article six, chapter twenty-nine
of this code.
(c) The director is responsible for the administration and
management of the Public Employees Insurance Agency as provided in
this article and in connection with his or her responsibility may
make all rules necessary to effectuate the provisions of this article. Nothing in section four or five of this article limits
the director's ability to manage on a day-to-day basis the group
insurance plans required or authorized by this article, including,
but not limited to, administrative contracting, studies, analyses
and audits, eligibility determinations, utilization management
provisions and incentives, provider negotiations, provider
contracting and payment, designation of covered and noncovered
services, offering of additional coverage options or cost
containment incentives, pursuit of coordination of benefits and
subrogation or any other actions which would serve to implement the
plan or plans designed by the Finance Board. The director is to
function as a benefits management professional and should avoid
political involvement in managing the affairs of the Public
Employees Insurance Agency.
(d) The director may, if it is financially advantageous to the
state, operate any of the health benefit plans offered by the
agency based on a plan year that runs concurrent with the calendar
year. Financial plans as addressed in section five of this article
shall continue to be on a fiscal year basis.
_____(d) (e) The director should make every effort to evaluate and
administer programs to improve quality, improve health status of
members, develop innovative payment methodologies, manage health
care delivery costs, evaluate effective benefit designs, evaluate
cost sharing and benefit based programs, and adopt effective industry programs that can manage the long-term effectiveness and
costs for the programs at the Public Employees Insurance Agency to
include, but not be limited to:
(1) Increasing generic fill rates;
(2) Managing specialty pharmacy costs;
(3) Implementing and evaluating medical home models and health
care delivery;
(4) Coordinating with providers, private insurance carriers
and to the extent possible Medicare to encourage the establishment
of cost effective accountable care organizations;
(5) Exploring and developing advanced payment methodologies
for care delivery such as case rates, capitation and other
potential risk-sharing models and partial risk-sharing models for
accountable care organizations and/or medical homes;
(6) Adopting measures identified by the Centers for Medicare
and Medicaid Services to reduce cost and enhance quality;
(7) Evaluating the expenditures to reduce excessive use of
emergency room visits, imaging services and other drivers of the
agency's medical rate of inflation;
(8) Recommending cutting-edge benefit designs to the Finance
Board to drive behavior and control costs for the plans;
(9) Implementing programs to encourage the use of the most
efficient and high-quality providers by employees and retired
employees;
(10) Identifying employees and retired employees who have
multiple chronic illnesses and initiating programs to coordinate
the care of these patients;
(11) Initiating steps by the agency to adjust payment by the
agency for the treatment of hospital acquired infections and
related events consistent with the payment policies, operational
guidelines and implementation timetable established by the Centers
of Medicare and Medicaid Services. The agency shall protect
employees and retired employees from any adjustment in payment for
hospital acquired infections; and
(12) Initiating steps by the agency to reduce the number of
employees and retired employees who experience avoidable
readmissions to a hospital for the same diagnosis related group
illness within thirty days of being discharged by a hospital in
this state or another state consistent with the payment policies,
operational guidelines and implementation timetable established by
the Centers of Medicare and Medicaid Services.
(e) (f) The director shall issue an annual progress report to
the Joint Committee on Government and Finance on the implementation
of any reforms initiated pursuant to this section and other
initiatives developed by the agency.
NOTE: The purpose of this bill is to permit the Director of
the Public Employees Insurance Agency to operate any of the
agency's health benefits plans on a calendar year if it is financially advantageous to the state. The bill provides that
financial plans shall continue to be on a fiscal year basis.
Strike-throughs indicate language that would be stricken from
the present law, and underscoring indicates new language that would
be added.