|Date Requested:March 02, 2009
Time Requested:04:44 PM
| FUND(S) |
Sources of Revenue
Legislation creates:Neither Program nor Fund
Effect this measure will have on costs and revenues of state government.
| This bill requires that the West Virginia Public Employee Insurance Agency (PEIA), as well as WVCHIP and other commerical insurers within the State of West Virginia to provide health insurance coverage that includes the prevention, early detection, diagnosis and treatment of autism spectrum disorder and other autism related disorders.
PEIA presently does pay for the diagnosis of autism spectrum disorder. The resulting claims for this type of testing costs the Plan approximately $50,000.00 per year. A review of the demographics of the PEIA Plan membership indicates the population of dependent children up to the age of twenty-six is 45,434 with a potentional addition of another 5,948 should the policyholders in the Managed Care Organizations (MCOs) that are currently available to our members should migrate back to PEIA coverage. By using the standard level of incidents for autism spectrum disorder of 0.65% for the PEIA dependent children PEIA could expect the population requiring the coverage defined in this bill to approximately 300.
PEIA estimates that approximately 130 of the 300 dependent children identified would require intensive services resulting in exhaustion of the maximum benefit of $50,000.00 for behavior therapy and then have high utilization for the other required benefits such as nutritionist visits and drug therapy prescribed by a treating health care provider. The remaining dependent children with autism spectrum disorder will require various levels of behavioral therapy and drug therapy that are not currently covered under the existing benefit offerings. It can be safety assumed that there will be a significate number of these children that are not considered in need of intensive services and are currently not undergoing behavioral therapy that will begin doing so when this benefit becomes available. All the costs associated with the delivery of these benefits would be an additional cost to the PEIA Plan.
Based upon these assumptions and including a projected medical cost increase trend of 10% PEIA expected the annual cost increase to the existing PEIA Plan to be as follows:
FY10 $ 8,400,000.00
FY11 $ 9,240,000.00
Total 3 year cost increase $27,805,000.00
|Effect of Proposal||Fiscal Year|
|1. Estmated Total Cost||4,000,000||8,400,000||9,240,000|
|Repairs and Alterations||0||0||0|
|2. Estimated Total Revenues||4,000,000||8,400,000||9,240,000|
3. Explanation of above estimates (including long-range effect):
PEIA used the existing accepted incident of austim spectrum disorder in children of 0.65% to determine the expected population within its present membership that potentionally will be using the mandated benefits set forth in this bill.
Since this bill includes requiring coverage for all prescription medications for autism spectrum disorder the 10% trend is based upon the current observed increases in both medical and drug costs.
|The PEIA Medical Director and the PEIA Staff have found in its research that many of the individuals affected by this disorder already have alternative coverage available through a variety of federally funded programs, including our State educational system. It is unclear whether this bill would adversely impact on the delivery of existing service or complicate the provider payment due to coordination of benefits between by these various groups.|