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.