October 30, 2018

Subcommittee recommends physician payment change

Physicians with offices in West Virginia and a bordering state may be paid in-state rates for PEIA members visiting their across-the-border offices. Members of the PEIA Task Force Coverage and Plan Subcommittee made this recommendation at an Oct. 29 meeting in Charleston. The recommendation must be approved by the full task force before action is taken recommending the change to the PEIA Finance Board.


PEIA is scheduled to discuss its plan, which begins July 01, 2019, at a series of public hearings. A quick review of the PEIA website does not show a schedule of these hearings. At a Sept. 30 meeting, the board approved a tentative hearing schedule as follows: Dial-in teleconference, Nov. 07; Cultural Center, Charleston, Nov. 08; Holiday Inn, Martinsburg, Nov. 13; WVU Erickson Alumni Center, Morgantown, Nov. 14; and Beckley-Raleigh County Convention Center, Beckley, Nov. 15.


A PEIA Finance Board October meeting scheduled to review the plan was “continued” until Nov. 11. A meeting notice has not been posted on the Secretary of State’s website.


PEIA Executive Director Ted Cheatham said costs for the change in physician reimbursement should be negligible if the physicians are willing to sign PEIA contracts accepting the program’s rate structure. The change applies only to physician office visits. It will not apply to out-of-state procedures available in West Virginia.


PEIA currently pays 70 percent of out-of-state procedures’ costs, as opposed to the 80 percent it pays for in-state procedures. During a series of task force public meetings held earlier this year, border county PEIA members complained about the out-of-state payment discrepancy. Cheatham told subcommittee members it would cost an additional $7.8 million to equalize the payments.


Another border-county complaint is PEIA’s maximum facility rate. PEIA pays a maximum in-state rate for common procedures. If these procedures, such as MRIs, are done at out-of-state facilities that charge a higher rate than the maximum facility fee, PEIA members must pay the difference. Cheatham said adjusting PEIA payments to out-of-state providers for these services would cost the program an additional $3.5 million.


He said the biggest area of concern for out-of-state providers is in the Eastern Panhandle. He said medical facilities located in Winchester, Virginia, just across the West Virginia border, can provide services not readily available to panhandle residents.


Members asked Cheatham to provide written responses to their payment concerns. Subcommittee Chairman Rob Alsop said the subcommittee will meet in the next two weeks to consider further recommendations.


Thought bubble: Discussion at today’s meeting was basically a rehash of the subcommittee’s Aug. 24 meeting. The Justice administration has received criticism for the task force taking no action. The governor’s chief of staff, Mike Hall, who is a member of the subcommittee, said all task force recommendations should be ready for presentation at December legislative interim committee meetings. Those meetings are scheduled Dec. 9-11.



Blue Ribbon Commission agrees to request $10 million to improve parity among college funding. WV News reports, “The governor’s blue ribbon commission on four-year colleges officially agreed … to request an additional $10 million to improve the parity among most of the colleges’ funding.”

…Recommendations listed. The Herald-Dispatch reports, “The new recommendation would give:..”




17th District Senate race pits newcomer against first-term incumbent. The Gazette-Mail reports, “Among state Senate races, the 17th District pits a political newcomer[Terrell Ellis] who believes the state is moving in the wrong direction against a first-term incumbent [Tom Takubo] who sees it moving forward.”


Abortion amendment implications go beyond funding. The Gazette-Mail reports, “A state constitutional amendment that would prohibit Medicaid from funding abortions could also have further-reaching effects on abortion rights in West Virginia, says both a legal expert and opponents.”


Three people seek two seats in 4th District. The Intelligencer reports, “Three people seek to fill two available seats to represent the West Virginia House of Delegates 4th District, which covers Marshall County and parts of Ohio County.”

Third District race is contest among neighbors. The Intelligencer reports, “The race to represent the West Virginia House of Delegates 3rd District is a contest among neighbors.


“Seeking re-election are delegates Erikka Storch, R-Ohio, and Shawn Fluharty, D-Ohio. They are being challenged by Republican Dalton Haas and Democrat Ben Schneider.”


More than just West Virginians paying attention to 3rd District Congressional race. The Herald-Dispatch reports, “The 3rd Congressional District of West Virginia is in the spotlight, with more than just West Virginians paying attention to the race between Republican Carol Miller and Democrat Richard Ojeda.”


PAC actions prompt legal action. The Gazette-Mail reports, “Outside groups have poured almost $200,000 into West Virginia’s legislative elections and bucked requirements that they report their donors, prompting legal action from the state.”



Supreme Court halts remaining impeachment trials. The San Francisco Chronicle reports, “West Virginia’s Supreme Court has effectively halted the legislature’s remaining efforts to impeach the state’s justices as a violation of the separation of powers doctrine.”


…Order states Workman case is closed. NPR reports, “The … order states that [Justice Margaret] Workman’s case is closed and implies that the original opinion applies to [former Justice Robin] Davis and [Justice Alan] Loughry.”


Texas adds opioid treatment drugs to Medicaid preferred drug list. The Austin Statesman reports, “State health officials … recommended adding several drugs that treat opiate addiction to the Medicaid preferred drug list, which could give addicts more treatment options, something doctors and lawmakers say is direly needed amid Texas’ growing opioid crisis.”



Anti-vaccine billboard goes up in Huntington. The Herald-Dispatch reports, “Driving down Hal Greer Boulevard in Huntington, you might catch a glimpse of the late Nicholas Catone’s smiling face, contrasted by a grim, red-lettered claim that the 20-month-old New Jersey boy’s death was caused by routine childhood vaccinations…


“…The Catones’ case is tragic, said Dr. Michael Kilkenny, physician director for the Cabell-Huntington Health Department, but the medical community’s consensus that vaccinations are safe and effective remains unchanged.”


Doctors Care of Cabell County ends services. The Herald-Dispatch reports, “Because of changes in health care, Doctors Care of Cabell County (DCCC) has decided to end its services.”


Flu vaccine expected to be effective. CBC reports, “The flu is expected to be mild to moderate this year and the vaccine effective for the strains of flu going around, according to Ottawa Public Health’s associate medical officer of health.”


Vaping has public health officials concerned. The Globe reports, “Though the extent to which southwest Minnesota teenagers are vaping remains somewhat unclear, flavored nicotine products in electronic cigarettes and similar devices continue to be an upcoming trend that has public health officials, advocates for teenagers and others concerned.”


2017-2018 flu vaccination rate lower. The CDC reports, “[Flu vaccinations] for 2017-18 [were] lower for every age group compared to the 2016–17 season… For all adult age groups, flu vaccination coverage estimates in the 2017–18 season were at their lowest levels compared with the seven prior flu seasons. For the 2017-18 season, flu vaccination coverage increased with age, from 26.9% among adults 18-49 years to 59.6% among adults ≥65 years.”


Advisory Committee on Immunization Practices recommends Hep A vaccinations for homeless. The Washington Examiner reports, “An advisory panel recommended for the first time … that homeless people receive vaccinations for the contagious liver disease hepatitis A.”


Public Safety

Ohio County voters get opportunity to learn about Public Safety Levy. The Intelligencer reports, “A $22 million levy to build a public safety building [in] downtown [Wheeling] goes before voters Nov. 6, and voters get one more opportunity to learn more about it.


“Police Chief Shawn Schwertfeger and Fire Chief Larry Helms will host a town hall to answer questions about the levy. The forum is set for 6:30 p.m. Monday at West Virginia Northern Community College in Wheeling.”

Leave a Comment

Error! This email is not valid.