December 5, 2018

HCA schedules hearing on CAMC’s $2 million+ Teays Ambulatory Center

According to a filing in the Nov. 30 edition of The State Register, the Health Care Authority is scheduling a prehearing conference and an administrative hearing on a request by Charleston Area Medical Center to develop a $2,438,000 ambulatory care facility at 3257 Teays Valley Road in Hurricane.

 

The prehearing conference is Feb. 06, 2019, at 1 p.m. The administrative hearing is Feb. 18 at 9 a.m. Scheduling of a prehearing conference and an administrative hearing generally means an “affected party” is protesting the application.

 

PEIA Task Force moves toward December report: considers out-of-state, drug costs

Following a series of statewide public hearings, Gov. Jim Justice’s PEIA Task Force spent most of the summer not meeting. Now they’re careening toward a self-imposed deadline to have ready recommendations by the December legislative interim committee meetings. Those meetings are set Dec. 09-11.

 

The Coverage and Plan Subcommittee met Tuesday at the Capitol with three major takeaways for the upcoming plan year:

 

Health care facilities in West Virginia-adjacent counties will receive the same 80/20 reimbursement as in-state facilities. This is a change from the current 70/30 reimbursement.

 

PEIA will institute an appeals process for its third-tier drugs. These are drugs for which PEIA members pay 75 percent of the market cost—which can often quickly reach the plan’s $1,750 cap for individual payments. PEIA Executive Director Ted Cheatham predicted 70 percent of the appeals will be approved. Costs will be bumped down to Tier 2, where the member pays a $25 or $50 copayment.

 

Some of the costs of these changes is being financed through savings generated by PEIA’s approval of a new third-party administrator. Cheatham said UMR has named the program’s third-party administrator, replacing HealthSmart. Cheatham said the $9 million of projected savings from the TPA will go to help defray the cost of increasing hospital reimbursement for facilities in adjacent states.

 

The full task force is scheduled to meet Dec. 10 at 1 p.m. to consider the subcommittee’s recommendations. The task force will then recess, allowing the Cost and Revenue Subcommittee to meet. The Task Force will reconvene to take up the final report to be submitted to the legislature and the PEIA Finance Board.

The Finance Board, which actually approves the program for the upcoming year, meets Dec. 21. House Speaker Roger Hanshaw, who serves on the task force and was at Tuesday’s meeting, did not seem overly enthusiastic about task force meetings held concurrently with a busy day of legislative interim committee meetings.

 

Legislature posts interim committee meetings

(All posted agendas are included.)

 

Sunday, Dec. 09

Joint Commission on Economic Development

House Government Organization

2-3 p.m.

 

Post Audits Subcommittee

Senate Finance

4-6 p.m.

Agenda

 

Monday, Dec. 10

Select Committee on PEIA, Seniors and Long-Term Care

House Finance

9-10 a.m.

 

Joint Standing Committee on Finance

House Chamber

10 a.m. – noon

 

Joint Standing Committee on the Judiciary

House Government Organization

10 a.m. – noon

 

Joint Committee on Government Operations

House Chamber

1-3 p.m.

Agenda

 

Joint Committee on Health

House Government Organization

1-3 p.m.

Agenda

 

Legislative Oversight Commission on Health and Human Resources Accountability

Senate Finance

5-7 p.m.

 

Tuesday, Dec. 11, 2018

Joint Committee on Children and Families

Senate Judiciary

1-3 p.m.

 

Joint Committee on Government and Finance

Senate Finance

3-4 p.m. 

Leave a Comment

Error! This email is not valid.