FISCAL NOTE
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 health insurance coverage for colorectal cancer examination and testing for individuals fifty years of age or older.
The Public Employees Insurance Agency (PEIA) currently complies with the legislation in regard to coverage for colorectal cancer examination and testing for individuals fifty years of age or older.
The PEIA has two concerns with the Bill which may have a fiscal impact:
1. The Bill amends §5-16-7a to require coverage for certain items provided by a provider licensed by the “West Virginia Board” of Medicine. Many PEIA members seek treatment out-of-state and it is unclear what this amendment would do to previously covered out-of-state claims; and
2. The general requirement that PEIA cover all “tests or testing generally accepted by the medical community” without more limitations, could cause unnecessary expenses to PEIA and diminish the quality of care to its members. One example of this is that the new language would mandate coverage of a “virtual colonoscopy” in all circumstances. PEIA currently covers a virtual colonoscopy, but only where medically necessary. A virtual colonoscopy is more expensive and less accurate than a traditional colonoscopy. PEIA currently only covers a virtual colonoscopy where the member is not a candidate for a traditional colonoscopy due to medical reasons. If a virtual colonoscopy produces a positive result in identifying a medical problem, a further traditional colonoscopy is then usually prescribed.
The Bill, as written, could increase PEIA’s costs, while potentially reducing quality of care. The PEIA cannot, however, precisely determine what the fiscal impact or cost at this time may be.
Fiscal Note Detail
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 |
Explanation of above estimates (including long-range effect):
Memorandum
1. The Bill amends §5-16-7a to require coverage for certain items provided by a provider licensed by the “West Virginia Board” of Medicine. Many PEIA members seek treatment out-of-state and it is unclear what this amendment would do to previously covered out-of-state claims; and
2. The general requirement that PEIA cover all “tests or testing generally accepted by the medical community” without more limitations, could cause unnecessary expenses to PEIA and diminish the quality of care to its members. One example of this is that the new language would mandate coverage of a “virtual colonoscopy” in all circumstances. PEIA currently covers a virtual colonoscopy, but only where medically necessary. A virtual colonoscopy is more expensive and less accurate than a traditional colonoscopy. PEIA currently only covers a virtual colonoscopy where the member is not a candidate for a traditional colonoscopy due to medical reasons. If a virtual colonoscopy produces a positive result in identifying a medical problem, a further traditional colonoscopy is then usually prescribed.
Person submitting Fiscal Note: Chip Myers
Email Address: clifford.m.myers@wv.gov