FISCAL NOTE
Date Requested: February 12, 2026
Time Requested: 05:22 PM |
| Agency: |
Tax & Revenue Department, WV State |
|---|
| CBD Number: |
Version: |
Bill Number: |
Resolution Number: |
| 3810 |
Introduced |
HB5470 |
|
|---|
| CBD Subject: |
Health |
|---|
|
FUND(S):
General Revenue Fund
Sources of Revenue:
General Fund
Legislation creates:
Fiscal Note Summary
Effect this measure will have on costs and revenues of state government.
The stated purpose of this bill is to bring the tax on healthcare managed care organizations into compliance with new federal regulations.
Per our interpretation, this bill would amend the sections of code entitled Fairness in Cost-Sharing Calculation in Articles 15, 16, 24, 25 and 25A of Chapter 33. These sections are amended by adding definitions for “health care service,” “health plan,” and “third-party administrator” and adding three new subsections. A new subsection is added requiring the application of federal ACA provisions relating to the annual limitation on cost sharing (out-of-pocket expenses) to all health care services. A second subsection is added which prohibits insurers, pharmacy benefit managers, and third-party administrators from designing or modifying health plan terms based on the availability or amount of financial or product assistance for a prescription drug. The final new subsection establishes civil penalties up to $10,000 for violations. The amendments are effective for policy, contracts, plans, or agreements beginning on or after January 1, 2027.
According to our interpretation, the provisions and taxes levied under Chapter 33. Insurance, fall under the jurisdiction of the Insurance Commission. Therefore, the State Tax Division cannot accurately address the impact of the bill. However, from a revenue perspective, the proposed bill should not have an impact on General Revenue collections.
There would be no additional administrative costs incurred by the State Tax Division. However, the Office of the Insurance Commissioner may incur additional administrative costs to administer the provisions of the bill.
Fiscal Note Detail
| Effect of Proposal |
Fiscal Year |
2026
Increase/Decrease
(use"-") |
2027
Increase/Decrease
(use"-") |
Fiscal Year
(Upon Full
Implementation) |
| 1. Estmated Total Cost |
0 |
0 |
0 |
| Personal Services |
0 |
0 |
0 |
| Current Expenses |
0 |
0 |
0 |
| 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):
Per our interpretation, this bill would amend the sections of code entitled Fairness in Cost-Sharing Calculation in Articles 15, 16, 24, 25 and 25A of Chapter 33. These sections are amended by adding definitions for “health care service,” “health plan,” and “third-party administrator” and adding three new subsections. A new subsection is added requiring the application of federal ACA provisions relating to the annual limitation on cost sharing (out-of-pocket expenses) to all health care services. A second subsection is added which prohibits insurers, pharmacy benefit managers, and third-party administrators from designing or modifying health plan terms based on the availability or amount of financial or product assistance for a prescription drug. The final new subsection establishes civil penalties up to $10,000 for violations. The amendments are effective for policy, contracts, plans, or agreements beginning on or after January 1, 2027.
According to our interpretation, the provisions and taxes levied under Chapter 33. Insurance, fall under the jurisdiction of the Insurance Commission. Therefore, the State Tax Division cannot accurately address the impact of the bill. However, from a revenue perspective, the proposed bill should not have an impact on General Revenue collections.
There would be no additional administrative costs incurred by the State Tax Division. However, the Office of the Insurance Commissioner may incur additional administrative costs to administer the provisions of the bill.
Memorandum
Person submitting Fiscal Note: Peter Shirley
Email Address: RADfiscal@wv.gov