HOUSE CONCURRENT RESOLUTION NO. 138

(By Delegates Ellington, Householder, Arvon, Cooper, Hill, Kurcaba, Rohrbach, Sobonya, Stansbury, Waxman, Westfall, Fleischauer, Campbell, Longstreth, Moore, Pushkin and Rodighiero)

[Originating in the Committee on Health and Human Resources; Reported March 10, 2015]

Requesting the Joint Committee on Government and Finance to study and review the managed care system within the Bureau for Medical Services.

            WHEREAS, The Bureau for Medical Services (BMS), Office of Medicaid Managed Care, initiated a risk-based managed care program for certain groups of Medicaid recipients in September 1996; and

            WHEREAS, The Managed Care Organization’s (MCO's) under contract with BMS are; Coventry Health Care of West Virginia, The Health Plan of the Upper Ohio, Unicare and West Virginia Family Health - - The name of the program is Mountain Health Trust; and

            WHEREAS, Under this program, the Bureau contracted with three MCO's for the provision of medically necessary services currently provided by the State, with the exception, most notably, of behavioral health, long term care and non-emergency medical transportation services, and

            WHEREAS, West Virginia ranks Number One in severe mental illness; and

            WHEREAS, Seventy percent of citizens who have behavioral health issue also has at least one chronic condition, decreasing their quality of life, and their mental state suffers from their inability to manage their health concern; and

            WHEREAS, According to a Public Works Audit commissioned by the Department of Health and Human Resources, they have recommended that the State of West Virginia integrate behavioral health into Mountain Health Trust’s Medicaid population; and

            WHEREAS, Managed care rates are based on “per payer, per month” system. The state pays each MCO a set rate based on the number of Medicaid patients it serves, regardless of their individual health-care needs; and

            WHEREAS, It is the intent of the legislature that West Virginia’s Medicaid population is properly maintained, while also providing that the Mountain Health Trust contract and implementation is actuarially sound and responsible; therefore be it 

Resolved by the Legislature of West Virginia:

            That the Joint Committee on Government and Finance is hereby requested to study and review the managed care contract within the Bureau for Medical Services; and, be it
            Further Resolved, That the Joint Committee on Government and Finance monitor, assess and provide assistance to the Bureau for Medical Services while it transitions it’s Medicaid population into Mountain Health Trust in insuring that it be actuarially sound and that administrative costs and medical loss ratio are consistent with national standards; and, be it
            Further Resolved, That Joint Committee on Government and Finance report to the regular session of the Legislature, 2016, 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 this study, to prepare a report and to draft necessary legislation be paid from legislative appropriations to the Joint Committee on Government and Finance.