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Senate sends PEIA reimbursement rate bill to House after unanimous vote

CHARLESTON, W.Va. — Some of the state’s largest hospitals would see their reimbursement rates for PEIA-covered patients nearly double in a bill approved on a unanimous vote Wednesday by the state Senate.

SB 574 increases the current 59% PEIA in-patient reimbursement rate to the hospitals to 110% of the Medicare reimbursement rate. The bill calls for a similar reimbursement increase for PEIA patients who use ambulance services through EMS.

Mike Maroney

Senate Health Committee Chairman Mike Maroney, R-Marshall, said PEIA would take the additional money for the hospitals and EMS from the agency’s reserve fund. Maroney said the move would force the legislature to come up with a permanent solution for PEIA funding in the coming years.

“This is not going to raise premiums initially but it is going to dip into the reserve fund which will need to be replenished. How that is replenished and where that money comes from and which percentage goes to the state and which percentage goes to the participants of the plan will be the subject of debate,” Maroney said.

State workers covered by PEIA haven’t had a premium increase since the 2017-2018 plan year. The bill originally included a premium increase for non-state employees covered by PEIA to cover the increase the reimbursement rates but senators removed it in a compromise agreement reached last week.

Jim Kaufman

West Virginia Hospital Association President Jim Kaufman said the increase in reimbursement rates will help the state’s larger hospitals like CAMC, Cabell-Huntington, St. Mary’s and Ruby Memorial. He said smaller hospitals already receive a higher reimbursement rate for PEIA patients.

“This is a true help for hospitals,” Kaufman said.

PEIA covers approximately 200,000 state workers and non-state employees, like sheriff’s deputies, county workers, etc. PEIA accounts for about 5% of hospital visits overall in West Virginia, Kaufman said.

“It’s a relatively small number because we’re fortunate most individuals enrolled in PEIA are healthy and don’t need a lot of hospitals services but the ones who do the reimbursements are so low it’s been a major burden on hospitals as we are trying to recruit and retain providers,” Kaufman said.

Tom Takubo

The bill now goes to the House of Delegates for consideration with just more than a week left in the 60-day session. Senate Majority Leader Tom Takubo, R-Kanawha, said Wednesday Gov. Justice is on-board with the bill.

“He also realizes that there’s a major issue that’s continuing to brew. He understands our hospitals are struggling and our EMS is struggling and that he has committed that this is one important piece of this,” Takubo said.

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