West Virginia senators could act on the first day of this week’s regular legislative session to bolster reimbursements from the Public Employees Insurance Agency to financially troubled medical providers.
“We have to take action. Others have not, so the Senate is going to,” said Senator Ryan Weld, D-Brooke. “It’s our plan right now to get it out on Day One.”
A longstanding problem grew urgent this week when Wheeling Hospital publicly announced it would stop accepting patients covered by the Public Employees Insurance Agency as of July 1.
The hospital is citing its financial struggles, compounded by PEIA’s traditionally low reimbursement rates.
“Our mission is to provide excellent healthcare. Health insurance companies like PEIA however must be good partners by supporting their members – our patients – by adequately reimbursing their hospitals and caregivers. That’s not the case with PEIA,” the statement contended.
The reimbursement rate for West Virginia medical providers has long been an issue. Other West Virginia medical providers face similar issues with reimbursement, and it’s not yet clear if they might follow suit in declining service through PEIA.
Right now, the state-defined reimbursement rate for PEIA amounts to 59 percent compared to the Medicare reimbursement rate.
“I’m not surprised,” Weld said on MetroNews’ “Talkline.” “We’ve known something like this was going to happen for a long time. Unfortunately, those who are in charge of PEIA just have refused to make any structural changes to the program, have refused to accept the realities that they are spending a lot more than they collect, and refuse to accept that something like this was going to happen.
“These reimbursement rates, which were just abysmal, were not paying for the services that were being provided by hospitals to their participants. So I, unfortunately, am not shocked by what happened.”
What is @RyanWeld's reaction to the Wheeling Hospital/PEIA issue? What is his take on what has been said as well? He joins @HoppyKercheval. WATCH: https://t.co/yCFQ3nEhk6 pic.twitter.com/0ZeGE8Jcle
— MetroNews (@WVMetroNews) January 6, 2023
Gov. Jim Justice’s administration released a statement last week saying the Wheeling Hospital announcement was surprising and disappointing.
“The Governor’s Office is discouraged by WVU Medicine’s position to stop accepting patients with PEIA at Wheeling Hospital. The Justice Administration has been extremely supportive of WVU Medicine’s acquisition of Wheeling Hospital,” stated C.J. Harvey, communications director for the administration.
“The West Virginia Hospital Association’s announcement today was a surprise to us, as we are engaged in good faith negotiations – and prior to this announcement today – had anticipated a resolution during the upcoming legislative session.”
WVU Medicine sent notification on behalf of Wheeling Hospital last June that it would halt participation with PEIA members starting this Jan. 1. “Righting the ship will require adjustment of PEIA rates at Wheeling Hospital,” the medical group wrote to PEIA.
Notably, that letter said WVU Medicine “will continue to monitor PEIA impact and will notify you of termination of any additional hospitals from PEIA,” indicating the possibility of other medical providers following suit.
The hospital group then sent a revised notification on Dec. 15 to move the termination date to June 30. That memo cited pledges of cooperation by Gov. Justice as the reason for the revised timetable.
What last week’s actions did was to make the termination date public, turning up heat right before the start of the legislative session.
Weld said there’s been plenty of time for the executive branch to start addressing the problem.
“What are they working on? I’m not throwing the Governor’s Office under the bus. But I just don’t understand what they’re working on. We’ve been trying to get a plan from PEIA and from their executive director for several months to try to deal with these provider payment issues and what is essentially their structural imbalance. But we don’t have anything,” Weld said.
Last year, the Legislature considered a bill that would have reimbursed state medical providers for PEIA at a rate of 110 percent the Medicare reimbursement rate. A fiscal note estimated the cost at $40 million.
The state Senate passed the bill unanimously, but the regular session ended without the bill passing the House of Delegates.
That’s the bill that Weld says will be considered right from the jump this coming week.
“That was something that we put a lot of thought and a lot of work into,” Weld said. Bringing it right back, he said, “is one way that we can make these decisions because others have refused to do so.”
Speaking at the West Virginia Press Association’s Legislative Lookahead on Friday, Senate President Craig Blair described quick action to avoid a cascade of medical providers following suit.
“Who didn’t see this coming? We did in the Senate. We passed a bill last year. Blair, R-Berkeley, told reporters.
“If we don’t do something fairly quickly on that, that is going to be contagious. You’re going to see other hospitals and providers stop taking PEIA and that cannot happen.”
Delegate Charlie Reynolds, R-Marshall, is the chairman of the House Committee on Workforce Development. In a letter to the governor, he said the PEIA issue needs to be resolved right away. He asked for a meeting among all interested parties.
“The taxpayers of West Virginia are getting the short end of the stick because two state-funded entities are at odds with each other,” Reynolds wrote.
“Governor Justice, at the end of the day, no matter how complex the are, our mutual constituents are losing substantial access to healthcare. Quite simply, this is government at its worst and my constituents deserve better. These issues need addressed immediately.”
Delegate Mike Pushkin, D-Kanawha, said he agrees the Legislature needs to address the reimbursement issue.
“That’s something that we need to address in this next session, the reimbursement rates for PEIA,” Pushkin said on “580 Live” on WCHS Radio. “We need to get that rate increase.”