WV Senate Health and Human Resources Committee passes SB-574
Members of the
“We’re not talking about PEIA negotiating with hospitals in general,” Haught said of the bill. “This bill strictly deals with PEIA’s negotiations in a non-state pool for inpatient rates only, nothing else.” Inpatient rates are currently not allowed to be negotiated in
Haught stated that the current reimbursement rate for all state PEIA employees for an inpatient hospital stay is close to 60 percent of the Medicare level. He prepared a fiscal note for the committee, which included a projection of increased claims expenses for the non-state employee pool.
According to the fiscal note summary, provided on the West Virginia Legislature’s website, the costs “will not affect the state.” Instead the costs will be “borne by entities and/or members participating in the non-state plan,” which consists of those employed by counties and municipalities. The projected model shows that if PEIA were to reimburse in-state hospitals at 125 percent of Medicare reimbursement levels, instead of the current 60 percent reimbursement level, annual claims expenses would increase by
Haught said that there are 14,800 policy holders included in the non-state employee fund with 30,600 members. PEIA charges each county or municipality a certain fee to be included in PEIA, and it is up to each county or municipality to determine how much their employees are required to contribute.
Committee Chair
Haught responded that he believes that is a fair statement.
Senator
“There is no question in my mind that we need to get a real fix, and get the entire hundreds of thousands of people paying being reimbursed at a fair rate. But … I’m not sure how big of an impact that is going to make on the overall picture,” Stollings said. “I just wonder if we are not aiming too low.”
Stollings later attempted to amend the bill to include not only non-state employees, but state employees as well. The amendment was voted down.
He noted that hospitals are facing increasing costs for both supplies and staffing. As is often the case, hospital staff will leave the state for larger paychecks elsewhere, creating a staff shortage at hospitals throughout
“A problem we have, obviously, if we are receiving less reimbursement, the fact that we are getting reimbursement below cost, our ability to even recruit people becomes a question because we can’t compete,” Lauffer said.
He explained that if a person were to be admitted to the hospital for an uncomplicated inpatient procedure “the revenue generated from commercial insurance is about
“There’s not enough commercial payers in the market for us to cover our costs,” Lauffer continued. “Why can I say that? We filed Chapter 11 a couple of years ago.”
“You may get to a point that individual hospitals start to say ‘You know what, we can’t accept that anymore,’” Kaufman said, discussing provider financial challenges. “I can’t say that’s been a discussion within our board members. However, I would not be surprised if individual hospitals are considering that.”
“I don’t think any provider wants to not serve their community,” he added. “However, you may get to a point financially where you can’t afford to.”
After discussion, where it was noted that this bill, if passed, is just a small step toward saving hospitals and PEIA, committee members voted to move SB 574 to the full
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