COMMITTEE SUBSTITUTE
FOR
H. C. R. 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
fund the Public Employees Insurance Agency health plan during the current year in a manner, if possible 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 representatives of each of the organizations 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, including, but not limited to the following: (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 examine the feasibility of preserving the current
indemnity plan, while also offering a voluntary system of physician
gatekeeping or care coordination; (f) to study the impact of
changing the benefit structure and increasing out-of-pocket costs
under the terms of the indemnity benefit plan; (g) to 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; (h) 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; (i) to investigate the
continuing feasibility and cost implications of the Public
Employees Insurance Agency health maintenance organizations;(j) to
conduct a comparison of the various HMO's offered to PEIA
beneficiaries and how these compare to the indemnity plan regarding
the utilization of emergency rooms; utilization of specialty
services; pharmacy benefits and costs; psychiatric services; level
of physician participation by community and specialty; rural access
and provider hours of operation; patient satisfaction; and care
outcomes; (k) the state medical schools must actively participate
in managed care options for PEIA policyholders and their dependents; (l) 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; (m) 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; and (n) monitor and
consider the impacts of federal developments which could positively
impact the Public Employees Insurance Agency Program, specifically
as to the following: the inclusion of pharmaceutical coverage under
the Medicare plan; Congressional action releasing the Health Care
Finance Authority from its subrogation obligation in relation to
tobacco settlement funds; and the work of the Congressional
Prescription Drug Task Force. 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.