Sources of Revenue:

General Fund,Other Fund Federal Funds

Legislation creates:

Neither Program nor Fund

Fiscal Note Summary

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

This bill requires that WVCHIP, as well as PEIA and other commercial insurers within the State of West Virginia, provide coverage for the prevention, early detection, diagnosis and treatment of autism spectrum disorder and other autism related disorders. Presently, WVCHIP does pay for the diagnosis of autism spectrum disorder, as well other related conditions listed in the bill. WVCHIP paid $37,148 in SFY 2008 for claims coded with diagnoses specific to the conditions listed in the bill. WVCHIP covered an estimated 37,645 children, ages 2-18 during SFY 2008. Autism is estimated to affect 0.65% of children in this age group, or an estimated 245 children during the year. Some of these children will require intensive 8 hour per day, 260 day per year service that will average around $156,200 for 2-5 year olds and $44,000 for 6-18 year olds. We estimate that 112 children will need intensive services related to their condition and 88 children will require less instensive services at estimated costs per child of $41,250 for 2-5 year olds and $22,000 for 6-18 year olds. Total estimated costs (trended for medical inflation) for these additional services are $3,389,863 (costs for 1/2 year) for SFY 2009, $7,118,711 for SFY 2010, and $7,474,647 for SFY 2011. State funds cover approximately 19% of program costs and federal funding covers the additional 81%.

Fiscal Note Detail

Effect of Proposal	Fiscal Year
Effect of Proposal	2009 Increase/Decrease (use"-")	2010 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	3,389,863	7,118,711	7,474,647
2. Estimated Total Revenues	0	0	0

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

Memorandum

WVCHIP is not sure the impact HB 2858 will have on its current program. Per current statute at §5-16b-6(c)(3), enrollment of children without insurance is to take precedence over enhancing benefits available under the program. The fiscal impact of HB2858 would definitely hinder the program's ability to cover the largest number of children it can with its available funding. The additional costs of services outlined in this bill equal the costs of allowing 3,802 children to access services under the program's current benefit structure in keeping with the original intent of §5-16B-6(c)(3). Also, under the federally mandated Payment Error Rate Measurement (PERM), WVCHIP claims are sampled and audited every three years to determine the number of claims paid in error. Although currently not required, in future audits WVCHIP will be expected to pay-back federal funds spent in error. One measurement relates to medical necessity. This bill appears to not allow the program to exercise fiscal/quality management by determining whether or not it will only provide payment for medically necessary service in respect to autism related diagnoses; it abrogates this role by allowing payment for any services deemed necessary by treating physicians and/or healthcare providers. The program is required to return the federal portion of any payments not deemed medically necessary under this audit, and would require 100% state funds to cover these expenditures (if not returned by the provider). WVCHIP also shares the same concerns outlined in PEIA's fiscal note response, FN2009R1127 and FN2009R2115.

Person submitting Fiscal Note: Stacey Shamblin
Email Address: Stacey.L.Shamblin@wv.gov