Date Requested:January 11, 2012
Time Requested:03:30 PM
Agency: Health and Human Resources, Department of
CBD Number: Version: Bill Number: Resolution Number:
2012R1068 Introduced SB2
CBD Subject: MEDICAID THERAPY PROGRAM
FUND(S)
8722 - Cons Federal Funds Div Human Services Gen Admn Fund; 0403 - Division of Human Services Gen Admin Fund
Sources of Revenue
General Fund,Other Fund Federal
Legislation creates:
A New Program

Fiscal Note Summary

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

    The purpose of this bill is to create a medication therapy management services program for Medicaid recipients. The bill permits licensed pharmacists to consult with Medicaid patients to ensure they are taking the appropriate drugs and the drugs are not interfering with one another. The bill sets forth the specific services to be provided by a pharmacist and eligibility requirements. The bill also provides for a pilot program for certain Medicaid patients. It is anticipated that administrative costs and medical services costs would increase as a result of this legislation, however the fiscal impact cannot be determined (see Memorandum Section below).
    
    

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:
Michael J. Lewis, M.D., Ph.D.
Email Address:
dhhrbudgetoffice@wv.gov
    Medication management services are a covered benefit to all Medicaid beneficiaries; however, payment is currently restricted to physicians. This bill would extend reimbursement to pharmacists for medication management services providing they meet certain eligibility criteria stipulated in the proposed legislation. This would be expected to increase medical and administrative service costs for the program.
    Approximately 43% of Medicaid eligible beneficiaries access pharmacy services each month; however, the Department is unable to determine how many of those individuals would meet the criteria in the proposed legislation nor can the Department determine how many pharmacists would be eligible to provide the service or the rate of reimbursement in the service settings stipulated in the bill. The Medicaid program is currently working to develop a State Plan Amendment (SPA) that would establish Health Homes for Medicaid members with certain targeted chronic conditions. The SPA includes a multidisciplinary team approach in addressing members health needs including medication management and reconciliation and can include pharmacists as care team members. This initiative appears to incorporate the same objectives provided in the proposed legislation. It is envisioned that a per member per month (PMPM) reimbursement will be paid to the health home; however, the Department has not finalized the reimbursement structure at this time.
    "Other States were contacted to assist in determining costs or outcomes associated with similiar programs. In one state, funding was appropriated but there was little participation or utilization of services; however, outcome studies were positive for improved care. Another state experienced $3M in associated administrative cost with little outcomes. This State subsequently partnered with a state university for $325K; however, they have not completed any outcome analysis. Based on other State's experience, the Department would anticipate that administrative support would be required for compliance with the provisions of this legislation."