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 bill required that the West Virginia Public Employee Insurance Agency (PEIA), as well as WVCHIP and other commerical insurers within the State of West Virginia to provide health insurance coverage that includes the prevention, early detection, diagnosis and treatment of autism spectrum disorder and other autism related disorders. PEIA presently does pay for the diagnosis of autism spectrum disorder. The resulting claims for this type of testing costs the Plan approximately $50,000.00 per year. A review of the demographics of the PEIA Plan membership indicates the population of dependent children up to the age of twenty-six is 45,434 with a potential addition of another 5,948 should the policyholders in the Managed Care Organizations (MCOs) that are currently available to our members should migrate back to PEIA coverage. By using the standard level of incidents for autism spectrum disorder of 0.65% for the PEIA dependent children PEIA could expect the population requiring the coverage defined in this bill to be approximately 300. PEIA estimates that approximately 130 of the 300 dependent children identified would require intensive services resulting in exhaustion of the maximum benefit of $50,000.00 for behavior therapy and then have high utilization for the other required benefits such as nutritionist visits; drug therapy prescribed by a treating health care provider; and unlimited occupational, physical and speech therapy visits. The remaining dependent with autism spectrum disorder will require various levels of behavioral therapy and other required coverage benefits. It can be safely assumed that there will be a significant number of these dependent children that are not considered in need of intensive services and are not currently undergoing behavioral therapy that will begin doing so when this benefit becomes available. All the costs associated with the deliver of these benefits would be an additional cost to the PEIA Plan. Based upon these assumptions and including a projected medical cost increase trend of 10% PEIA expects the annual cost increase to the existing PEIA Plan to be as follows: FY10 $ 8,570,000 FY11 $ 9,425,000 FY12 $10,370,000 Total 3 year cost increase $ 28,365,000. The difference of the total expected cost of this bill from another bill very similar to it is the unlimited speech, occupational and physical therapy benefit required in this bill version and is not present in the other.

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	4,080,000	8,570,000	9,425,000
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	4,080,000	8,570,000	9,425,000

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

PEIA used the existing accepted incident of austim spectrum disorder in children of 0.65% to determine the expected population within it present membership that potentially will be using the mandated benefits set forth in this bill. Since this bill included requiring coverage for all prescription medications for autism spectrum disorder the 10% trend is based upon the curren observed increases in bothe medical and drug costs.

Memorandum

The PEIA Medical Director and the PEIA Staff have found in its research that many of the individuals affected by this disorder already have alternative coverage available through a variety of federally funded programs, including our State education system. It is unclear whether this bill would adversely impact on the deliverly of existing services or complicate the provider payment due to coordination of benefits between these various groups.

Person submitting Fiscal Note: J. Michael Adkins, Deputy Director
Email Address: michael.adkins@wv.gov