HOUSE CONCURRENT RESOLUTION NO. 34
(By Mr. Speaker, Mr. Kiss, and Delegates Martin and Hubbard)

Requesting the West Virginia State Legislature to study the current condition of the Public Employees Insurance Agency health plan, and to review the effects of changes in benefits and provider reimbursements approved by the Finance Board in December 1998, and to recommend possible future legislative action which may be undertaken to improve policies and procedures of the Public Employees Insurance Agency and which will assure plan policyholders and their dependents continued access to quality health care at fair and affordable rates.

Whereas, Benefits from the Public Employees Insurance Agency health plan are paid to approximately 200,000 West Virginia citizens each year, including 30,000 employees of state agencies, 33,000 employees of County Boards of Education, 25,000 retirees, and 7,000 employees of other political subdivisions within the state, and the dependents of these policyholders. These benefits are an essential component of the compensation paid to these employees of state agencies and other political subdivisions. Access to quality health care at affordable rates is a reasonable expectation of the workers covered by the Public Employees Insurance Agency health plan, as it is a reasonable expectation of all citizens of the state. 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
Whereas, The Public Employees Insurance Agency has been amended and changed many times in the past, without long-lasting success toward the goals of creating a secure, affordable health plan for state workers and other employees of public agencies in the state and 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 implementing effective programs that will support the health care needs of all state citizens; and
Whereas, The Legislature recognizes the need for adequate funding of the Public Employees Insurance Agency in order to meet its obligations to the workers of the State and the need to call upon all stakeholders 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 will make every effort to continue to fully fund the Public Employees Insurance Agency health plan during the current year so that no policyholder will be required to pay more out-of-pocket to maintain the current level of health coverage for themselves and their families; and, be it
Further Resolved, That the Speaker of the House and the President of the Senate are hereby requested to appoint a commission to include members of the House and Senate and will also include representative of each of the unions recognized as representatives of the employees covered by the Public Employees Insurance Agency health plan in order to assure that the policyholders of the Public Employees Insurance Agency have a role in developing solutions to the problems experienced by the health plan. The commission shall be directed to review, examine and study the effects of the legislative acts governing the Public Employees Insurance Agency, and to develop recommendations to the Legislature as to policies, programs and practices which may be instituted: (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 effective managed health care 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) research the restructuring of the prescription drug program, including the increase in out-of-pocket costs, the implementation of a drug formulary and other plan modifications and assess the projected cost savings, and 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 Employee Insurance Agency; (i) the state medical schools must actively participate in managed care options for PEIA policyholders and their dependents; (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, out-of-state usage, in order to examine alternative processes and procedures that will serve to hold costs down while not hindering access to necessary care; and (k) to study other options for holding costs down and providing incentives to health care consumers and providers to practice appropriate care, including providing rewards to policyholders who report provider over billing, interviewing providers whose cost and utilization profiles are consistently outside the normal patterns of practice. The commission shall study administrative processes and procedures of the Public Employee 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 and to assure that claims processing, including collection of coinsurance due from other carriers, is expeditious and accurate. The commission 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 commission 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. The commission shall have authorization from the Legislature to request, receive and examine all reports, documents, testimony, actuarial and financial information or analysis and any other such material as it may be deemed necessary for the commission to accomplish its goals; and, be it
Further Resolved, That the commission will begin its meetings and deliberations no later than sixty days after the adoption of this resolution, and is directed to report to the Legislature by January 1, 2000, on its findings, conclusions and recommendations, together with drafts of any legislation it may deem necessary to effectuate any recommendations it may make.