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 provide insurance for the detection and treatment of autism. The bill requires PEIA, CHIP, commercial health care insurers within the State of West Virginia to provide coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder. The bill further requires that coverage must be provided at out-of-state facilities as a full in-state or in-network benefit. Presently PEIA does pay for the diagnosis of autism spectrum disorder. A review of the demographics of the PEIA Plan membership there are 28,001 children insured by PEIA that could be between the ages 2 and 15 and that population would have the probability of the autism spectrum disorder based upon the standard definition of the disorder of .65%, or approximately 182 members. PEIA projects the extension of this coverage to increase the first year annual costs to the Plan of $6.8 million. Future costs would trend upward with the rising costs of health care delivery, presently assumed to be approximately 8%. Based upon a quick review of the services provided within the State of West Virginia it is apparent that most of the services required for persons of this disorder would not be available within West Virginia. Without the ability to set reimbursement rates for those services provided out-of-state PEIA would have to pay much more than it would for comparable services within the State’s boundaries. This would likely increase the aforementioned estimate by 30% or approximately $ 8,840,000.00 in the first year. While it was expected that the limit on behavioral therapy would reduce the cost earlier quoted, a deeper study into the programs provided these children the earlier estimate will remain the same. Fiscal Year Increase to the PEIA Plan FY-09 $ 8,840,000.00 FY-10 $ 9,547,200.00 FY-11 $10,310,976.00 Total $28,698,176.00 Special Issues: A quick review by the Medical Director and staff of PEIA disclosed 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 services or complicate the provider payment due to coordination of benefits between these various groups. This required payment for services outside the State of West Virginia may also hinder the growth of any infra-structure development of services for this particular population.

Fiscal Note Detail

Effect of Proposal	Fiscal Year
Effect of Proposal	2008 Increase/Decrease (use"-")	2009 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

Explanation of above estimates (including long-range effect):

Memorandum

Person submitting Fiscal Note: Chip Myers
Email Address: CLIFFORD.M.MYERS@WV.GOV