Date Requested:January 11, 2012
Time Requested:03:27 PM
Agency: Public Employees Insurance Agency (PEIA)
CBD Number: Version: Bill Number: Resolution Number:
2012R1067 SB1
CBD Subject: COLORECTAL SCREENING MANDATE
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 colorectal cancer examination and testing for individuals fifty years of age or older.
    The Public Employees Insurance Agency (PEIA) currently complies with the legislation in regard to coverage for colorectal cancer examination and testing for individuals fifty years of age or older.
    The PEIA has two concerns with the Bill which may have a fiscal impact:
    1. The Bill amends §5-16-7a to require coverage for certain items provided by a provider licensed by the “West Virginia Board” of Medicine. Many PEIA members seek treatment out-of-state and it is unclear what this amendment would do to previously covered out-of-state claims; and
    2. The general requirement that PEIA cover all “tests or testing generally accepted by the medical community” without more limitations, could cause unnecessary expenses to PEIA and diminish the quality of care to its members. One example of this is that the new language would mandate coverage of a “virtual colonoscopy” in all circumstances. PEIA currently covers a virtual colonoscopy, but only where medically necessary. A virtual colonoscopy is more expensive and less accurate than a traditional colonoscopy. PEIA currently only covers a virtual colonoscopy where the member is not a candidate for a traditional colonoscopy due to medical reasons. If a virtual colonoscopy produces a positive result in identifying a medical problem, a further traditional colonoscopy is then usually prescribed.
    The Bill, as written, could increase PEIA’s costs, while potentially reducing quality of care. The PEIA cannot, however, precisely determine what the fiscal impact or cost at this time may be.
    

Fiscal Note Detail
Over-all effect
Effect of Proposal Fiscal Year
2012
Increase/Decrease
(use"-")
2013
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
    1. The Bill amends §5-16-7a to require coverage for certain items provided by a provider licensed by the “West Virginia Board” of Medicine. Many PEIA members seek treatment out-of-state and it is unclear what this amendment would do to previously covered out-of-state claims; and
    2. The general requirement that PEIA cover all “tests or testing generally accepted by the medical community” without more limitations, could cause unnecessary expenses to PEIA and diminish the quality of care to its members. One example of this is that the new language would mandate coverage of a “virtual colonoscopy” in all circumstances. PEIA currently covers a virtual colonoscopy, but only where medically necessary. A virtual colonoscopy is more expensive and less accurate than a traditional colonoscopy. PEIA currently only covers a virtual colonoscopy where the member is not a candidate for a traditional colonoscopy due to medical reasons. If a virtual colonoscopy produces a positive result in identifying a medical problem, a further traditional colonoscopy is then usually prescribed.