The Legislature’s Joint Standing Committee on Finance met Monday morning at the Donald F. Black Courthouse Annex for the second day of September legislative interim meetings in Parkersburg.

The focal point of the meeting was continued (from August interims two weeks ago) questioning of West Virginia Department of Human Services officials regarding where state and federal funding for child care subsidies comes from, as well as the seeming lack of progress in attempting to combat the state’s substance use disorder crisis.

Senate Finance Committee Chairman Eric Tarr (R-Putnam) asked Cynthia Persily, the cabinet secretary for the Department of Human Services, exactly how the state funds the Child Care Assistance program through the Bureau for Family Assistance. The program provides financial assistance to working parents or parents attending public colleges to subsidize the cost of family-based child care or licensed center-based child care for families that meet income requirements.

Persily explained that the Child Care Assistance program receives its funding though the child care development fund made up of state dollars and a line of child care maintenance from federal funding. The program is also receiving funding through two federal funding block grants and TANF surplus dollars according to Persily.

Persily informed members that the Child Care Assistance Program receives just over $124 annually, with over $116 million coming from federal dollars and $7.9 million in state funding.

Delegate Matthew Rohrbach (R-Cabell) asked Persily about state funding to combat the substance use disorder crisis in West Virginia, and the state’s apparent lack of return on investment.

Two weeks ago, the Joint Standing Committee on Health received a bleak report from Jeremiah Samples, a senior adviser to the Legislature, regarding West Virginia’s drug use statistics and policies.

Citing statistics from the U.S. Centers for Disease Control and Prevention, Samples informed members that overdose deaths in West Virginia between 2017 and 2022 increased by more than 55 percent, overdose deaths between 2010 and 2022 increased by 135 percent, and overdose deaths between 1999 and 2022 increased by 1,690 percent.

Rohrbach mentioned Monday that state spending on the West Virginia substance use disorder waiver — which helps pay for prevention and treatment services — was $13 million in fiscal year 2019, growing to $160 million in fiscal year 2024. He wondered how state spending could increases by more than ten times in five years as overdose deaths continue to skyrocket?

Persily said that looking at substance use disorder treatment with only overdoses as a measurement of success fails to produce a true reflection of the good work that is being done. She said other measures to consider include seven-day and 30-day follow-ups with those who complete rehabilitation and connecting individuals with housing and employment.

“We are not just looking at overdoses as the end result of SUD treatment, because quite frankly people who are in treatment are less likely to have overdoses than people who are not in treatment,” Persily said.

She also reminded lawmakers of a law they passed earlier this year, requiring automatic enrollment of the substance use disorder population into managed care programs. The bill requires DoHS to develop performance-based outcome measures for state-funded substance use disorder programs.

Persily said the DohS proposed those measures and she believes those managed care programs are indicators of success nationally in the fight against substance use disorder.

The Legislature is in Parkersburg for interims this week. Today, the Judiciary Committee heard about cemetery law.

There are regulations on company cemeteries. However, many cemeteries in West Virginia are privately owned by families and churches. Privately owned cemeteries are exempt from regulations, although many try to abide by the regulations laid out for company cemeteries. Cemetery abandonment, neglect, and damages can arise when there is insufficient funding, staffing, or volunteers to upkeep the cemeteries.

West Virginia has code on cemeteries, but it is a bit scattered and focuses on criminal damage rather than abandonment, neglect, or weather damage.

Ohio code covers abandoned cemeteries by stating that a trustee can turn over the cemetery to a municipality or county by stating that they cannot maintain it. In Kentucky, the Attorney General’s Office handles cemeteries. Pennsylvania allows for 25 citizens in a five-mile radius to petition the township if a cemetery is in disarray. In Maryland, there is a regulatory board for cemeteries and the county/municipality can appropriate or raise funds for cemeteries. Virginia can take over cemeteries with eminent domain if they aren’t being cared for.

If someone in West Virginia needs help with a cemetery that is neglected, damaged, or abandoned, they can contact state or local government, contact the insurance company for the cemetery, reach out to volunteer groups, apply for grants, if a natural disaster – contact FEMA or contact other buyers to purchase the cemetery.

Scott Adkins, West Virginia’s unemployment secretary, told members of the Legislative Oversight Committee on Workplace Development Tuesday that for every unemployed person in West Virginia there are about one and a half jobs available.

The number of unemployed state residents stands at 33,100 according to the most recent figures. There are currently around 48,000 job openings in the state.

West Virginia’s unemployment trust fund balance currently sits at more than $420 million, a figure Adkins described as “pretty healthy.”

While describing job market figures as relatively stable, Adkins gave the example of West Virginia’s seasonally adjusted unemployment rate, usually about 4.1 to 4.3 percent and currently standing at 4.2 percent for the most recent month, July 2024. The unemployment rate is  the percentage of people in the labor force who are unemployed. An unemployed person is defined as working age, available for work and be taking steps to find a job.

According to Adkins, as of August 23, Workforce West Virginia showed 10,772 West Virginians receiving unemployment benefits.

Adkins said the state currently has nearly 19,000 people determined to be eligible for unemployment and receiving their first week of benefits, a figure that is up 15 percent compared to a year ago.

The average duration of unemployment across all sectors went from 12.9 weeks in the second quarter of 2023 to 13.4 weeks through June 30, 2024. Adkins said 12-14 weeks duration is fairly typical.

West Virginia’s workforce participation rate, long a sore spot in the state’s economic outlook, currently stands at 55.1 percent according to Adkins. The workforce participation rate includes both people who are employed and those who are looking for work. The figure is calculated by dividing the labor force by total adult population. The national workforce participation rate is 62.7 percent.

Members of the Joint Standing Committee on Finance heard from Division of Human Services Cabinet Secretary Cynthia Persily on Monday morning, the second day of August interim meetings.

During  April interim meetings the DoHS told lawmakers the department would need $2.3 million per month, or about $23 million, to fund the Child Care Assistance program at the current rate beginning in September for the remaining 10 months of the current fiscal year. The additional funds were needed to abide by new federal rules that take effect in September requiring states to fund child care providers based on enrollment at individual facilities instead of attendance.

Persily informed lawmakers that funding for the program was coming from surplus dollars in the Temporary Assistance for Needy Families (TANF) program. While the program is currently projected to have adequate funding through the end of the year, Persily said it is hard to predict when that funding will run out.

Lawmakers questioned Persily as to why DoHS is not using funds set aside for the department in the May special session. The Legislature passed a bill in May restoring more than $5 million to the Department of Health and more than $183 million to DoHS. The bill allows the secretaries of the departments to transfer money out of these new reserve funds to provide money for other line items. Persily said they had no plans to touch that funding until the fourth quarter – April, May, and June – of the current fiscal year.

In other news in the meeting, with Republican lawmakers consistently expressing support for phasing out the personal income tax over time, Senate Finance Committee Chairman Eric Tarr, (R-Putnam), asked Department of Revenue Deputy Secretary Mark Muchow about the state’s six-year revenue and expenditure forecast and whether revenue officials were factoring in future costs that could affect tax revenues in out-years.

Muchow said that the recent trend in record-breaking end of year tax revenue surpluses are likely coming to an end for the time being.

“It’s unusual to have huge revenue surpluses like we’ve had here in recent years,” Muchow said. “There’s a lot of factors that generated those huge revenue surpluses, including trying to keep the budget pretty flat. Over the long run, our revenues are going to be more in line with spending, and you’re not going to see every year a $400 million or $500 million surplus.”

Tarr and other lawmakers have been frustrated about being blindsided by the governor’s request for the additional 5 percent personal income tax cut, with legislative leaders not consulted.

“If there’s further discussion that’s had about accelerating a tax cut beyond the economic growth of the State of West Virginia with our projected expenses in mind, could you bring that explanation or have somebody from the Governor’s Office bring that explanation to this committee at some time before session,” Tarr asked.

The Committee on Insurance and PEIA met this afternoon to discuss the rollout of the updated prior authorization law in West Virginia. The goal of the updated law is to promote and require electronic prior authorizations (EPAs) among healthcare providers and insurers. EPAs reduce administrative burden and allow for the bundling of services and treatments for each episode of care. An episode of care requires one prior authorization to treat a specific ailment, even if the treatment drugs, procedures, services, etc. All must be submitted on the patient’s EPA. This enhances timely patient care.

In 2019, House Bill 2351 was passed to require insurers to accept EPAs as of July 1, 2020. The bill required forms to be available online with an electronic portal for EPAs to be submitted and for it to be accessible on the insurance provider’s website. If providers change, EPAs are required to be carried over for 3 months. EPAs must include a comprehensive list of treatments. Insurers must inform patients if step therapy protocols are in place for specific treatments. Insurers must confirm receipt of EOA and review and respond promptly.

In 2023, Senate Bill 267 mandated the EPA usage of all healthcare providers. The bill continued the requirement of episode of care and the 3-month carryover. The bill also required the portal address to be provided on insurance cards. The bill added the reporting requirement to the Office of the Insurance Commissioner and the Inspector General of the DHHR. The bill also added civil penalties for violating prior authorization law.

A Gold Card provider is exempt from prior authorization requirements. The exemption may be awarded to providers based on their prior authorization track record. On average, they must provide 20 procedures a year and in 6 months have a 90 percent final prior approval rating. If requirements are met, providers may not have to submit prior authorizations for 6 months.

The timeframe requirements are that the insurer must respond in 5 business days for non-life threatening or routine medical care. For life-threatening or nonroutine medical care, insurers must respond in 2 business days. If the EPA is incomplete, insurers must return the EPA to the provider within 2 days for the provider to update and resubmit.

Data reporting is quarterly and includes the number of EPAs requested by providers, total denied, total appealed, total approved after appeal, providers with gold card status, and providers who’ve had goal card status revoked.