Date Requested:February 29, 2012
Time Requested:03:04 PM
Agency: Public Employees Insurance Agency (PEIA)
CBD Number: Version: Bill Number: Resolution Number:
2012R1542 Comm. Sub. HB4426
CBD Subject: CO-PAY FOR PHYSICAL THERAPIST
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 a copayment to a physical therapist and an occupational therapist be the same as a physician or osteopath.
    The Public Employees Insurance Agency (PEIA) has concerns over language in the proposed bill in regards to the definition of the term copayment. In the text of the bill “copayment” means a specific dollar amount that the covered individual must pay as a share of the cost of the services upon receipt of the covered services.
    The PEIA currently administers this benefit with a copayment, payment of an allowable provider fee balance, which is subject to a deductible, and then a coinsurance amount. It is the interpretation of the agency that pursuant to the Bill, the cost of the physical therapy benefit can’t be more than the cost of a physician office visit and that the Bill would effectively disallow deductible and coinsurance, since they are not a “specific dollar amount”, from being applied the way the benefit is currently paid. Should this be the case, those amounts previously paid by the insured would instead be shifted to the insurance program thus posing a direct cost to the PEIA.
    The claims processed in 2011 have been recalculated from where coinsurance and deductible were charged to members. The recalculated claims were then compared to the primary care physician copayment and concluded that the therapy member share would be in excess $15.00.
    In determining the cost of the bill it has been assumed the PEIA must change to a $15.00 copayment and forego the annual deductible and coinsurance. For purposes of this projection 146,870 therapy visits at a benefit variance of $10.52 has been utilized resulting in a cost to the PEIA of $1,545,724 the first year. Assuming an 8% trend subsequent year costs are $1,669,382 and $1,802,933 for a total three year cost of $5,018,039.
    Upon passage of this legislation the PEIA would have to either raise premiums or implement benefit changes to fund the insurance program.
    

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