Date Requested:February 04, 2011
Time Requested:11:05 AM
Agency: Public Employees Insurance Agency (PEIA)
CBD Number: Version: Bill Number: Resolution Number:
2011R1371 Revised HB2442
CBD Subject: COVERAGE FOR AUTISM SPECTRUM DISORDERS
FUND(S)
2180
Sources of Revenue
Special Fund
Legislation creates:
Neither Program nor Fund

Fiscal Note Summary

Effect this measure will have on costs and revenues of state government.

    The purpose of this bill is to require health insurance coverage for autism spectrum disorders. The bill sets forth the types of coverage required and requires therapeutic services to be provided on a nondiscriminatory basis. The bill also defines terms.
    
    The Public Employees Insurance Agency (PEIA) presently pays 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 PEIA membership demographics indicates approximately 53,000 dependent children. By using the standard level of incidents for autism spectrum disorder of .91% for PEIA dependent children it is expected that the population requiring the coverage defined in this bill to approximately 483.
    
    The PEIA estimates that approximately 217 of the 483 dependent children identified would require intensive services resulting in exhaustion of the maximum benefit of $36,000.00 for behavior therapy and then have high utilization for the other required benefits such as drug therapy prescribed by a treating health care provider and occupational, physical and speech therapy visits. The remaining dependents with autism spectrum disorder will require various levels of behavioral therapy and other required coverage benefits. It can be safely assumed that there will be a significant number of these dependent children that are not considered in need of intensive services and are not currently undergoing behavioral therapy that will begin doing so when this benefit becomes available. All costs associated with the delivery of these benefits would be an additional cost to the program.
    
    Based upon these assumptions it is projected the annual cost to the PEIA to be as follows:
    
    FY-2012 $ 9,940,000
    
    FY-2013 $10,934,000
    
    FY-2014 $12,027,400
    
     Total $32,901,400
    

Fiscal Note Detail
Over-all effect
Effect of Proposal Fiscal Year
2011
Increase/Decrease
(use"-")
2012
Increase/Decrease
(use"-")
Fiscal Year
(Upon Full
Implementation)
1. Estmated Total Cost 0 0 0
Personal Services 0 0 0
Current Expenses 0 0 0
Repairs and Alterations 0 0 0
Assets 0 0 0
Other 0 0 0
2. Estimated Total Revenues 0 0 0
3. Explanation of above estimates (including long-range effect):
    


Memorandum
Person submitting Fiscal Note:
Chip Myers
Email Address:
clifford.m.myers@wv.gov