COMMITTEE SUBSTITUTE
FOR
H. C. R. 34
(By Mr. Speaker, Mr. Kiss, and Delegates Martin and Hubbard)
[Adopted March 13, 1999]

Requesting the President of the Senate and the Speaker of the House of Delegates to appoint a task force to conduct a study of the Public Employees Insurance Agency health plan and to review the effects of changes in benefits and provider reimbursement.

Whereas, Benefits from the Public Employees Insurance Agency health plan are paid to approximately two hundred thousand West Virginia citizens each year, including thirty thousand employees of state agencies, thirty-three thousand employees of county boards of education, twenty-five thousand retirees and seven thousand employees of other political subdivisions within the state, as well as the dependents of these policyholders; and
Whereas, Access to quality health care at affordable rates is a reasonable expectation of the workers covered by the Public Employees Insurance Agency health plan and it is a reasonable expectation of all citizens of West Virginia; and
Whereas, There is a critical need to develop methods which will assure the availability of all necessary medical care and hospitalization for the policyholders of the Public Employees Insurance Agency health plan at costs that can be reasonably borne by the plan and the enrollees; and
Whereas, The Legislature is desirous of developing a long- lasting solution to the problems of rising health care costs within the Public Employees Insurance Agency health plan and within the state as a whole; and
Whereas, The Legislature is desirous of implementing effective programs that will support the health care needs of all West Virginians and promote the practice of appropriate medical care within the state; and
Whereas, The Legislature recognizes the need to call upon all entities of the Public Employees Insurance Agency in order to develop a permanent and acceptable solution to the problems of rising health care costs; therefore, be it
Resolved by the Legislature of West Virginia:
That the Legislature hereby requests the President of the Senate and the Speaker of the House of Delegates to appoint a task force to conduct a study of the Public Employees Insurance Agency health plan and to review the effects of changes in benefits and provider reimbursement; and, be it
Further Resolved, That the task force shall include members of the Senate and House of Delegates appointed by the President of the Senate and the Speaker of the House of Delegates, respectively; and, be it
Further Resolved, That the task force should also include representatives of several of the employee unions that are covered by the Public Employees Insurance Agency health plan in order to assure that the employees have a role in developing solutions to the problems experienced by the health plan; and, be it
Further Resolved, That the task force shall be directed to review, examine and study the Public Employees Insurance Agency and to develop recommendations to the Legislature as to policies, programs and practices which may be instituted, including: (a) To guarantee the continuation of an affordable health plan that assures access to all necessary medical care; (b) to educate policyholders of the Public Employees Insurance Agency health plan of the issues affecting the cost of the plan and their continued access to quality health care with the goal of encouraging cost effective utilization of the health program; (c) to promote the use of in-state health providers and providers who participate in cost effectiveness of the preferred provider network framework that was incorporated into the indemnity benefit plan; (d) to examine the feasibility and cost effectiveness of the preferred provider network framework that was incorporated into the indemnity benefit plan; (e) to study the impact of changing the benefit structure and increasing out-of-pocket costs under the terms of the indemnity benefit plan; (f) to research the restructuring of the prescription drug program, including the increase in out-of-pocket costs, implementation of a drug formulary and other plan modifications, and assess the projected costs savings to determine alternative plan changes; (g) to examine the potential cost impact and health outcomes associated with the introduction of preventive care and wellness programs in conjunction with the indemnity plan; (h) to investigate the feasibility and cost implications of establishing a health maintenance organization for policyholders of the Public Employees Insurance Agency; (i) to assess the feasibility of the state medical schools actively participating in managed care options for Public Employees Insurance Agency policy holders and their dependants; (j) to review the cost and utilization statistics of various elements of the Public Employee Insurance Agency health plan, including emergency room usage, psychiatric and mental health care, prescription drugs, retiree health benefits, and out-of-state usage, in order to examine alternative processes that will serve to hold costs down while not hindering access to necessary care; (k) to study other options for holding costs down and providing incentives to health care consumers and providers to practice appropriation care, including providing rewards to policyholders who report provider overbilling and interviewing providers whose cost and utilization profiles are consistently outside the normal patterns of practice; and, be it
Further Resolved, That the task force shall study administrative processes and procedures of the Public Employees Insurance Agency to assure that information and computer systems are providing adequate and accurate support to the agency in terms of enrollment and data reporting, and make recommendations for updating such systems to assure that claims processing, including collection of coinsurance due from other carriers, is expeditious and accurate; and, be it
Further Resolved, That the task force shall be directed to study the financial impact of all recommendations and proposed changes upon the current and future cost of the Public Employees Insurance Agency and to determine whether enough savings will be generated to adequately fund the health program for the future; and, be it
Further Resolved, That the task force shall have authorization from the Legislature to call upon representatives of other health care purchasers within the state and other health care consumer representatives in order to learn their experience with the state's health care delivery system and to determine the feasibility of developing purchasing coalitions with private sector health care purchasers as a method for keeping health costs down; and, be it
Further Resolved, That the task force report to the Joint Committee on Government and Finance by July 1, 1999, on its findings, conclusions and recommendations, together with drafts of any legislation necessary to effectuate its recommendations; and, be it
Further Resolved, That the expenses necessary to conduct the duties of the task force, to prepare a report and to draft necessary legislation be paid from legislative appropriations to the Joint Committee on Government and Finance.