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.

Colleen Hilton, founder and  & CEO of Alli Connect, gave a presentation to the committee regarding the company’s app that can provide digital mental heath services to first responders.

Hilton told the committee that first responders are notoriously hesitant to seek mental help because of trust and privacy reasons and because they have traditionally thought they should be immune to such issues.

She also explained that most mental health programs are reactive, in that if a first responder is seeking help — and usually by that time they’ve got a major problem — the first responder has to find it on their own.

That process doesn’t provide data insights and doesn’t make customized recommendations for an individual first responder based on their specific needs.

Hilton told members that she hopes Alli Connect’s app can change that by treating first responders quickly, before a mental health crisis occurs, while protecting user privacy.

Hilton explained that this AI-powered wellness solution helps to match a first responder with a counselor based on needs and specialization. The platform is both mobile and web-based.

Alli Connect began serving emergency response agencies in Washington state and has recently expanded into Texas, Illinois and Alabama.

Hilton, a licensed therapist for over 20 years, explained the technology.

“It not only takes a proactive approach for the individual, but also streamlines the process of getting them to the correct care in a timely manner, and really leaning on tech and AI, machine learning to do that, so we really have a scalable, accurate solution,” Hilton said.

The key to the Alli Connect service is early detection, and one of the barriers to early detection is confidentiality and privacy.

“So we know through our tech that everything is private,” Hilton said. “We provide them with the tools where they can do their own self-assessment and understand wellness and resilience from a baseline and track that over time so we’re not waiting for a crisis to happen.”

Lawmakers expressed optimism about this technology and were hopeful that West Virginia could utilize it in the future. According to data provided, the state has lost first responders by suicide in each of the last five years.

The Joint Committee on Education met this afternoon. First, the committee received an update on the implementation of House Bill 3035 and House Bill 5405.

HB 5405 provides for the professional development of educators. According to the Superintendent, the Department of Education is planning to use the $14 million over several years. The funds will be used to provide additional math specialists ($3.5 million) and provide K-3 teachers and administrators with development in the science of reading ($5.4 million). The remaining $5.1 will be used to help support less certified teachers to become fully certified and provide professional development for other teachers.

The bill also provided $1 million for county grants. The department will be awarding up to 20 $25,000 grants to counties in January or February 2025. Counties will also have the option to receive an additional $25,000 in year two. An additional grant period may be scheduled if all funds aren’t awarded in round one.

House Bill 3035 is the Third Grade Success Act. The goal is to have 80 percent fidelity in the next three years. This year, over 1,700 teachers attended the Summer INVEST Conference in Morgantown and Charleston. Funding for the act is coming from the Early Literacy Fund ($5.7 million) and the Mathematics Fund ($886,000). The Department will work with schools to set goals, provide action steps, and continue data collection.

To impact student achievement, schools must address basic needs, attendance, discipline, and mental health. To address these, the department is using resources that already exist. In an initiative called STRIVE WV, the department is pointing students and educators to resources that already exist in the state for student well-being and school success. STRIVE WV = Strengthen Behavior responses, Targeted assistance, Regular assistance, Increased achievement, Valid data practices, and Empower support teams.

Finally, the committee heard from HBCU Bound Athletics about attracting student-athletes to WV’s historically black colleges and universities. The non-profit organization helps lower-income high school students with recruiting to colleges to bring more student-athletes to WV with a focus on HBCUs. The goal is to show students what resources are available to them for college and educate them on what scholarships are available and what they need to attend college as an athlete.

The Legislative Oversight Commission on Education met this afternoon.

The Commission received an update on the Federal Application for Federal Student Aid (FAFSA). The Chancellor stated that 43,540 students received the Higher Education Grant or Promise for the 2024-2025 academic year. With new funding the Higher Education Grant was able to be double the award to $6,800 and a College Access Grant of $2,000 was able to be provided to students who needed additional help. Due to last year’s delay and issues with the new FAFSA guidelines, paper applications were filled out and are still being processed. With the new FAFSA process, institutions will not be able to do bulk corrections this year, which is placing an administrative burden on the institutions. The Higher Education Policy Commission did receive a grant to fund a marketing campaign. The HEPC intentionally did not put dates on the advertising material so that it could be used in future years.

The HEPC is concerned about 2025 FASFA. The US Department of Education has already pushed the FASFA application availability from October to December. The Commission is fearful of another delay.

The Legislature’s efforts in May were extremely helpful for students.

The Commission also heard about WVBE Policy 2423 – Health Promotion and Disease Prevention. The policy hadn’t been updated in nine years and the Board of Education felt it was time for an update. The Policy sets the standards for county policies relating to student health, prevention of disease, and educating students and school personnel on communicable diseases.

The School Discipline Report was provided to the Commission. Professional Training will be provided to principals in October regarding discipline, expectations of behaviors, and multi-tier support available. Over 80 percent of students in WV schools are behaving in a manner that does not require discipline. Of the children getting in trouble, several are receiving in-school suspension. Out-of-school suspension is only assigned if a student is a repeat offender or if the behavior is severe. The top three suspension reasons are possession of a controlled substance, threatening harm to others, and possession of a deadly weapon.
Commission members requested additional data and for comparisons to be made between previous years and now.

Finally, the Commission received the student transfer report.

The Legislative Oversight Commission on Health and Human Resources met this evening. The first presentation was about state health facilities, specifically Hopemont. Deficiencies were identified and an improved plan of correction is in place. Details could not be discussed; however, the completed surveys are available here.

The commission also received an update from the Department of Health Facilities. Over the last ten months, improvements have been made within the facilities regarding staffing, although more improvements could be made. Strategic plans are being developed.