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.
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