FISCAL NOTE

Date Requested: February 09, 2017
Time Requested: 09:45 AM
Agency: Health and Human Resources, WV Department of
CBD Number: Version: Bill Number: Resolution Number:
2080 Introduced SB175
CBD Subject: Health


FUND(S):

N/A

Sources of Revenue:

Other Fund N/A

Legislation creates:

Neither Program nor Fund



Fiscal Note Summary


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


The purpose of this bill is to permit the practice of direct primary care agreements between patients and physicians, whereby a regular membership fee would be paid for primary care services. The Department does not estimate a fiscal impact related to this bill, however, clarifications (as indicated in the memorandum section) should be included to ensure no negative fiscal impact to the Medicaid program.



Fiscal Note Detail


Effect of Proposal Fiscal Year
2017
Increase/Decrease
(use"-")
2018
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):






Memorandum


In the bill, 30-3F-2(c) states that direct primary care providers (DPCP's) may accept payment from Medicaid for services or medical products. This provision is ambiguous, as it could be read to mean that DPCP's are permitted to be enrolled in Medicaid, or that DPCP's can balance bill Medicaid. Federal Medicaid regulations require that any provider enrolled in Medicaid must accept Medicaid as payment in full for covered services provided to members. West Virginia's Medicaid policies applying this regulation only permit a provider which accepts Medicaid to treat a Medicaid member as a private pay patient under limited circumstances, requiring waivers to be signed, explanations, etc. Further, these DPCP plans could be interpreted as allowing a Medicaid provider to directly charge the member cash instead of taking the Medicaid member's Medicaid. This interpretation could be mitigated if the legislation did not involve Medicaid with DPCP arrangements, including prohibiting DPCP's from selling them to Medicaid members and from balance billing Medicaid at all, whether fee for service or some other basis, and whether for services or products. It is recognized that 30-3F-2(f) indicates DPCP's may not bill ""third party payers"" for "" ""fee for service"", which may take care of the balance billing issue, although it still potentially conflicts with 30-3F-2(c); however, clarification that this applies to all types of billing (such as encounter rate billing) and that it also applies to products, not just services, could help to ensure there is no negative financial impact to Medicaid.



    Person submitting Fiscal Note: Bill J. Crouch
    Email Address: dhhrbudgetoffice@wv.gov