FISCAL NOTE

Date Requested: January 14, 2019
Time Requested: 03:10 PM
Agency: Public Employees Insurance Agency (PEIA)
CBD Number: Version: Bill Number: Resolution Number:
1169 Introduced HB2399
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 establish universal forms and establish deadlines when a prior authorization is submitted electronically. There is potential for administrative cost increases to PEIA due to requirements set forth in this bill. In the event another care standard is purchased and adopted by the third-party administrator (TPA,) the requirement for MCG (formerly known as Milliman) utilization in West Virginia would cause additional costs as the TPA will be required to own and administer multiple care standards to service PEIA. These criteria software applications cost approximately $200,000 per year. The requirement to utilize Milliman/MCG criteria is also a concern as it is not all inclusive and other care standards are necessary at times due to the specifics of the request. It is recommended the bill be revised to allow for an approved and appropriate standard per the specifics of the request. The current TPA is URAC compliant. Currently, all requests deemed urgent care services as defined by URAC standards are responded to within 24 hours. There is potential for conflict with URAC standards regarding the definition of urgent care services. There are also differences with some of the bills timeframe requirements as compared to State Law, NCQA, Medicare and DOL requirements. A possible revision to require utilization of an acceptable accrediting agency, or applicable State or Federal law might be considered. The determination of which to follow would be dependent on the location of delivery of the service, the type of service or patient type. If this bill will include prior authorizations for services rendered outside of West Virginia, there is potential for cost increases in the event the review is processed by the out of state network administrator. The cause would be similar to those outlined above for the in-state prior authorizations.



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 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):


Please explain increases and decreases in personal services, current expenses, repairs and alterations, assets, other costs and revenues, including assumptions and data sources and delineation between start-up and ongoing costs. Please also include a long-range schedule of costs and revenues if fiscal impact is expected to vary in future years.



Memorandum


There is potential for administrative cost increases to PEIA due to requirements set forth in this bill. In the event another care standard is purchased and adopted by the third-party administrator (TPA,) the requirement for MCG (formerly known as Milliman) utilization in West Virginia would cause additional costs as the TPA will be required to own and administer multiple care standards to service PEIA. These criteria software applications cost approximately $200,000 per year.



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