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WHEELING — West Virginia Senate Majority Whip Ryan Weld said a possible legislative solution to the current Public Employees Insurance Agency reimbursement issues could be worked out as soon as Wednesday — the first day of the West Virginia Legislature’s upcoming regular session.
On Thursday, WVU Medicine Wheeling Hospital announced it would no longer accept PEIA patients, citing inadequate reimbursement at that hospital and others around the state.
But Weld, R-Brook, noted last year that the Senate passed Senate Bill 574, which calls for increasing PEIA reimbursement rates for state hospitals.
He asked Senate President Craig Blair, R-Berkeley, if the bill could be brought back on the first day of the session, and Blair agreed.
“There was a bill in the Senate (SB 574) that we passed unanimously last year,” Weld continued. “We did this in recognition that nobody was doing anything to improve reimbursement rates and we wanted to avoid an announcement like that (on Thursday).”
The legislation, introduced by Sen. Mike Maroney, R-Marshall, was not addressed in the House.
It calls for raising state hospital reimbursement rates from 59% to 110% of the federal Medicare reimbursement rate.
“In light of what happened (on Thursday), I asked Senate President Blair if we could do this bill on Day 1 of the legislature because of the enormity of the problem, and knowing that it needs to be addressed,” Weld said. “There may be other solutions, but this is the one we are all familiar with.
“There has always been a huge structural imbalance in PEIA’s program and it needs to be remedied. We have to find a permanent solution.”
Union leaders representing Ohio county school workers told members they still have their Public Employees Insurance Agency — at least until July 1 — and that they should contact their state lawmakers now to make sure the issue is a priority at the start of the upcoming legislative session. .
Jerry Ames, president of the Ohio County School Service Personnel Association, said he called WVU Medicine’s central business office in Morgantown twice Thursday and gave them his name and his title as president of OCSSPA.
Both times various employees read him an email verbatim that they told them “should be resolved quickly.”
He made an additional call on Friday morning and was told the same thing.
“I’ve had three people tell me that (the issue will be resolved), and I take them at their word,” Ames added.
A message left to the same office Friday from the Sunday News-Register was not immediately returned.
Ames expects a statement to be released soon indicating that PEIA coverage at Wheeling Hospital will continue beyond July 1.
“I don’t want our people to fear not knowing if they will be insured. I feel sorry for them,” Ames said.
For now all employees have medical insurance with PEIA health coverage, he continued.
“It’s as good as gold now,” Ames added. “The date given was July 1.”
Thursday’s move by Wheeling Hospital comes less than a week before West Virginia lawmakers convene for their regular session in Charleston.
Ames called the pulling of PEIA coverage by Wheeling hospitals “a scare tactic” because they are seeking higher reimbursement rates for the procedure. He also isn’t sure what will happen in the Legislature this session regarding PEIA funding.
Lawmakers are looking at how to spend the $1.3 billion budget surplus and there is likely to be discussion about using some of the money to shore up the PEIA system.
“Why aren’t they allowing more reimbursements?” Ames asked. “Then they have a surplus. Maybe it needs to be reallocated in a different way.
“They have to leave the concern about a (proposed) 10% tax reduction, or inventory tax reduction. It is a big political game.”
Ohio County Education Association President Jenny Craig urged those who have PEIA insurance – even if they choose the health plan option as their coverage – to contact their legislators this weekend before the regular session begins Wednesday to explain the importance of PEIA.
He has been talking to legislators himself, as well as other state officials. One question among them all is whether public employees who choose health plan options offered to them instead of the PEIA option will be affected by the WVU Medicine-Wheeling Hospital decision.
WVU Health System President and CEO Albert Wright confirmed Friday that the health plan option will be included in Wheeling Hospital’s PEIA mandate. Reimbursements from PEIA and Health Plan Options are about the same, Wright said.
“We have a lot of concerns,” Craig said. “Our hope at the (West Virginia Education Association) is that during the legislative session, much better work will be done to fund PEIA and resolve it so that both members and hospital systems are able to afford and receive PEIA coverage. This is a goal that WVEA has been fighting for since 2018 (teachers’ strike).
“There will be pressure on the Legislature to intervene and ensure that PEIA insurance is solvent and affordable enough not only for members to take up hospital coverage.”
Although Wheeling Hospital is the only hospital that has announced it will no longer accept PEIA insurance after July, Craig noted that the fear is that others in the WVU Medicine System and other hospitals in the state may soon follow suit.
“Reimbursement rates are low, and work needs to be done this session to correct the differences,” he continued. “So it’s important to make it a priority early in the session.”
The Wheeling Hospital announcement affects not only teachers and school staff, but state troopers, corrections officers and city and government employees. And according to Craig, most public employees in West Virginia get coverage through PEIA.
“Funding PEIA has to be a new top priority at the start of the session or there will be a crisis,” he said. “We have to have a long-term funding solution.”
Craig admits he’s not sure what that will look like.
He noted that the Legislature has committed to fully funding PEIA and a reliable funding stream following the teachers’ strike in 2018. A task force was formed to look into the matter, “but it hasn’t been seen in two years,” he continued.
School staff often skip health screenings, surgeries and doctor appointments until the summer when they have time and often their families, Craig explained.
Another problem is that many local doctors are affiliated with Wheeling Hospital, and finding a primary care physician locally is already difficult, he added.
“July 1 is not a long time – just a few months, and that’s only if everyone can act quickly,” Craig continued. “Our members need to communicate on foot next week so that the Legislature makes it a priority when the session begins. Now is the time to do it before the session starts.”
Rep. Charlie Reynolds, R-Marshall, released a statement Friday indicating he sent a letter to Gov. Jim Justice about the PEIA issue.
He said in the letter that the PEIA issues “need to be resolved immediately.”
“My constituents and residents of the entire Northern Panhandle are being severely affected by this decision because an extraordinarily high percentage of my constituents rely on PEIA and WVU Medicine for their health care needs,” Reynolds wrote. “West Virginia taxpayers are getting the short end of the stick as two state-funded agencies are at odds with each other.
“Government justice, at the end of the day, no matter how complicated the issues, our mutual constituents are losing substantial access to health care,” he continued. “Quite simply, this is the worst government and my constituents deserve better. These issues need to be addressed immediately. Accordingly, I request that your office immediately coordinate and participate in a meeting involving all interested parties and myself to address and resolve these very important issues. I look forward to working with everyone to resolve these issues as soon as possible.”
