FISCAL NOTE

Date Requested: January 10, 2019
Time Requested: 03:31 PM
Agency: Public Employees Insurance Agency (PEIA)
CBD Number: Version: Bill Number: Resolution Number:
1642 Introduced HB2224
CBD Subject: Insurance


FUND(S):

PEIA Basic Insurance

Sources of Revenue:

Special Fund

Legislation creates:

Increases Existing Expenses



Fiscal Note Summary


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


The purpose of this bill is to expand the age range for breast cancer screening procedures for females age 30 to 40 years old and a comprehensive ultrasound if certain indications for high risk or dense breast tissue are present. This bill will increase costs to the PEIA plan. The bill would also require PEIA to cover services not recommended by the 2015 American Cancer Society Breast Cancer Screening Guidelines. Current standards recommend an opportunity for regular cancer screening at age 40. PEIA’s current benefit provides screenings starting at age 40. Ultrasounds can increase cancer detection in dense breast tissue. However, the majority of cancer screening guidelines state there is insufficient evidence to recommend ultrasound as an adjunctive screening tool. In addition, breast cancer screening guidelines from the major societies recommend high risk individuals to be screened with mammography and an MRI annually, not ultrasound. It has been and remains PEIA’s steadfast belief that healthcare benefits should be based on ever-changing standards of care and not included in law. These standards of care are always fluid, as ongoing research provides scientific data that may revise previous standards. By including benefit requirements in law, plan stakeholders are exposed to requirements that may not be in compliance with contemporary care standards. PEIA has approximately 12,000 female members 30 to 40 years of age. PEIA has assumed the new population will utilize benefits at the same rate of the existing members currently recommended for breast cancer screening. Currently 73% of women greater than 40 years of age utilize breast cancer screening procedures. After removing the 2,200 existing members below age 40 already receiving breast cancer screenings, there will be 7,250 new members eligible for screenings. Since this bill allows for one screening for female members between the ages of 30 to 40, members will have varying time to utilize the new benefit. This makes it difficult to assume when the utilization will occur. PEIA has assumed 20% of the eligible members will utilize the benefit annually in the first five years of their eligibility period. These assumptions will result in $33,000 of additional cost for fiscal year 2020. This is half of the full year costs as it goes into effect January 2020. The subsequent full fiscal year trended at 3% will result in an annual cost of $69,000. Eventually after all the current, newly eligible 30 to 40-year-old members have utilized the benefit over their 10-year eligibility period, trending at 3% per year, the total cost is estimated to be $346,000.



Fiscal Note Detail


Effect of Proposal Fiscal Year
2019
Increase/Decrease
(use"-")
2020
Increase/Decrease
(use"-")
Fiscal Year
(Upon Full
Implementation)
1. Estmated Total Cost 0 33,000 69,000
Personal Services 0 0 0
Current Expenses 0 33,000 69,000
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):


PEIA has approximately 12,000 female members 30 to 40 years of age. PEIA has assumed the new population will utilize benefits at the same rate of the existing members currently recommended for breast cancer screening. Currently 73% of women greater than 40 years of age utilize breast cancer screening procedures. After removing the 2,200 existing members below age 40 already receiving breast cancer screenings, there will be 7,250 new members eligible for screenings. Since this bill allows for one screening for female members between the ages of 30 to 40, members will have varying time to utilize the new benefit. This makes it difficult to assume when the utilization will occur. PEIA has assumed 20% of the eligible members will utilize the benefit annually in the first five years of their eligibility period. These assumptions will result in $33,000 of additional cost for fiscal year 2020. This is half of the full year costs as it goes into effect January 2020. The subsequent full fiscal year trended at 3% will result in an annual cost of $69,000. Eventually after all the current, newly eligible 30 to 40-year-old members have utilized the benefit over their 10-year eligibility period, trending at 3% per year, the total cost is estimated to be $346,000.



Memorandum


Please identify any areas of vagueness, technical defects, reasons a bill would not have a fiscal impact, and/or any special issues not captured elsewhere on this form.



    Person submitting Fiscal Note: Jason Haught
    Email Address: jason.a.haught@wv.gov