CHARLESTON, W.Va. — One of the casualties in the final days of the legislature’s 60-day session was a bill that would have increased the reimbursement rates for some of the state’s largest hospitals that treat PEIA-covered patients.
SB 574 passed the state Senate and was on track to pass the House until House leadership moved several bills to its inactive calendar last Thursday.
West Virginia Hospital Association President Jim Kaufman told MetroNews Monday he believes a majority of lawmakers are in favor of raising the PEIA reimbursement rate but the question comes down to how to finance it.
“There were some questions about the appropriate way to fund it,” Kaufman said.
The bill that passed the Senate increased the current 59% PEIA in-patient reimbursement rate to the hospitals to 110% of the Medicare reimbursement rate. The bill called for a similar reimbursement increase for PEIA patients who use ambulance services through EMS. Those increases would be paid for out of PEIA’s reserve funds.
The House questioned that move and discussed raising the premiums of spouses covered by PEIA. Neither funding plan appeared to have full support among delegates.
Kaufman said he believes they aren’t far from finding a solution.
“They recognize that paying hospitals at 50% of the Medicare level when Medicare doesn’t cover cost at 100% is a huge issue and they need to fix it, the question is how to pay for it,” Kaufman said.
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.
It’s an access to care issue, Kaufman said.
“The challenge that we have is that we can’t offer competitive salaries to clinicians and the number one reason that nurses have left West Virginia is salaries and if we’re only getting reimbursed at 50% of the Medicare level how can we offer competitive salaries?”
Kaufman said the hospitals would suffer further if the issue is ignored until next year’s regular session. He hopes to get the bill on a special session agenda.
“I think this is an issue that we need to work with policymakers on immediately,” Kaufman said. “We look forward working with (Senate) President (Craig) Blair, (House) Speaker (Roger) Hanshaw and the governor’s office to figure out how we fix this problem as soon as possible,” Kaufman said.
State workers covered by PEIA haven’t had a premium increase since July 1, 2017. 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 that passed the Senate on March 2. The House Finance Committee changed the bill and sent it to the House floor early last week. The bill was one of several bills placed on the House’s inactive calendar last Thursday when work stalled in the House in a debate on the controversial anti-racism bill.
PEIA-covered patients make up about 5% of overall hospital visits in West Virginia.