Members of the state Legislature previewed an action that could play a role in alleviating some medical costs affecting the Public Employees Insurance Agency.
During the next legislative session, lawmakers could consider a bill reining in compensation for some medical providers. The Legislative Oversight Committee on Insurance and PEIA got a brief preview of the bill during a Monday meeting at legislative interims.
“As we’ve continued to look into PEIA and the cost, we have a bill that we’re going to present,” said Delegate Matthew Rohrbach, R-Cabell.
PEIA has been at the center of public discussion in West Virginia because medical and drug expenses have outpaced the money available for the insurance program for state workers and retirees.
The state insurance agency is trying to close an anticipated $113 million gap through increasing premiums, deductibles and other costs for people who are insured.
One of the factors in medical costs has been reimbursement rates to medical providers.
Last year, lawmakers responded to complaints that healthcare providers were having trouble making ends meet because of the state insurance’s traditionally low reimbursement rate.
Lawmakers passed a 2023 bill making reimbursement rates for medical providers 110 percent of the federal Medicare rate.
The legislation that could be considered in the coming regular session could tinker with that 110 percent rate for some providers.
Delegate David Green, R-McDowell, asked about the percentage that providers currently receive for medical services.
The legislative counsel for the committee explained that depending on the service being provided or paid for, the reimbursement might be more than 110% of the Medicare rate. “The code currently permits that practice by saying that they are permitted to pay a minimum of 110% of Medicare, but this bill would reduce all of those rates to the 110% level.”
Counsel for the committee said PEIA administrators have been asked for a fiscal note to get a better handle on the cost savings that could occur if the proposed bill were to pass.
During a previous round of interim legislative meetings last month, PEIA Director Brian Cunningham suggested lawmakers might want to re-examine the 110% requirement for some providers.
“So one thing that the legislature can consider is clarifying the rule in Senate Bill 268 around 110% of Medicare,” Cunningham told lawmakers.
“What we’d like to consider at PEIA is not paying 110% to all healthcare providers. And in fact, what we see in PEIA is that we are overpaying compared to national averages for some services.”