Introduced Version
Senate Bill 695 History
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Key: Green = existing Code. Red = new code to be enacted
Senate Bill No. 695
(By Senators Prezioso, Foster, Hunter, Unger, Bailey, Sharpe,
Minard and Jenkins)
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[Introduced February 20, 2006; referred to the Committee
on Health and Human Resources; and then to the Committee on
Finance.]
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A BILL to amend the Code of West Virginia, 1931, as amended, by
adding thereto a new section, designated §5-16-7f, relating to
the establishment of a pilot project within the Public
Employees Insurance Agency to offer state employees and
retirees
primary care, preventative care, wellness screens,
chronic disease management and other services; setting forth
selection criteria; providing for health screening of
participants prior to participation; setting forth
requirements for the health screen; providing for
reimbursement for the testing; setting forth evaluation
criteria of the program; and reporting to the Legislative
Oversight Commission on Health and Human Resources
Accountability.
Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended
by adding thereto a new section, designated §5-16-7f, to read as
follows:
ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT.
§5-16-7f. Quality Primary Care Pilot Project.
(a) Findings. The Legislature finds that the rising cost of
health care, including the raising cost of treatment of chronic
diseases and the increasing cost of pharmaceuticals for
participating employees and retirees, has had a significant impact
on the ability of the Legislature to fund other programs. The
Legislature also finds that while the agency has been a leader in
the development of work site wellness initiatives and disease
management initiatives, there is no central collection of data from
participation in these programs. The Legislature further finds
that electronic medical records and billing claims electronic has
the potential to improve quality of care and reduce medical cost.
The Legislature further finds that it is important to evaluate
pilot projects to determine whether resources can be conserved and
whether the health status of individuals can be improved through
participation in pilot projects.
(b) Program design. (1) On or before the first day of
January, two thousand seven, the director shall establish a pilot
project with five health clinics or private physician offices. The five clinics or offices will be selected in geographically
dispersed areas of the state. In selecting the five pilot projects
the director shall give priority to clinics or physician offices
that have installed electronic medical records and who are billing
the agency electronically, and those clinics or physician offices
that can dispense pharmaceuticals in a cost effective manner.
(2) The five pilot projects will offer to participating
employees and retirees primary care, preventative care, wellness
screens, chronic disease management and other services specified by
the director. Prior to receiving services from the five pilot
projects, each participating employee or retiree will complete a
health risk assessment and blood or other physical test that will
provide a baseline measurement of whether the employee or retiree
is a smoker or other user of tobacco products, their LDL cholesterol
levels, their HDL cholesterol levels, their body mass index, their
hemoglobin A1C levels, cardio vascular risk assessment, and other
measures required by the director. The data from these screens or
test shall be reported to the agency electronically. Each
participating employee or retiree who receives services from a pilot
project clinic or office for more than six months shall complete the
same health risk assessment or test prior to December, two thousand
eight and prior to December, two thousand nine. The data from these
screens or test shall be reported to the agency electronically.
(3) The five pilot projects will be reimbursed for test, screens and services provided to participating employees and
retirees at a rate mutually agreed by the director and the five
pilot projects. If the director finds that any of the pilot
projects has had a net savings to the agency and has improved the
health status of the participating employees or retirees, he or she
may increase the reimbursement to the successful clinic or office.
If the director finds that any of the pilot projects has failed to
produce a net savings to the agency or the overall health status of
the employees or retirees who utilize the services of the clinic or
physician office has not improved, the director may reduce payment
to the unsuccessful clinic or office or discontinue the agency's
participation with the clinic or physician office in the pilot
project. Clinics or physician offices that participate in the pilot
project may not drop a participating employee or retiree without
good cause. If a clinic or physician office drops a participating
employee or retiree, the clinic or office shall notify the director
within seventy-two hours and provide a detailed explanation of why
the participating employee or retiree was dropped.
(4) The finance board may reduce deductibles or copayments or
provide other incentives to employees and retirees to participate
in the pilot project.
(c) Evaluation. On or before the first day of January, two
thousand eight, and on or before the first day of January, two
thousand nine, the director shall report an analysis of the pilot project to the Joint Committee on Government and Finance. The
report shall include an analysis of the cost to the agency and any
identified savings to the agency. The report shall also include an
analysis of the number of participating employees or retirees who
used tobacco products prior to participating in the pilot project,
and the number who have successfully quit using tobacco products.
The report will also include an analysis of what impact, if any,
participation in the pilot project had on participating employees'
and retirees' body mass index, LDL cholesterol levels, HDL
cholesterol levels, and hemoglobin A1C levels.
NOTE: The purpose of this bill is to establish a pilot program
of five participating clinics selected by the Public Employees
Insurance Agency to monitor health risk of participating state
employees and retired state employees over a two year period in an
attempt to encourage healthy living among the participants.
This section is new therefore, strike-throughs and underscoring
have been omitted.