March 30,2023
PEIA Finance Board approves premium-only increase
To the surprise of really no one, the PEIA Finance Board Thursday accepted the plan for state and non-state employees that only increases PEIA premiums. Other proposals called for a smaller premium increase and a substantial cost increase to the PEIA member.
The increase specifically lives up to the provisions of SB 268, passed by the legislature and approved by the governor. That hard-fought bill increases PEIA premiums by almost 25 percent. This year’s premium increase is offset by a $2,300 across-the-board pay increase for most state employees. Non-state employees, who did not receive a salary increase, will see a rise in premiums of approximately 15 percent. Non-state entities with employees insured by PEIA have the option of apportioning the premium increase, including absorbing the increases in their budgets.
Labor leaders speaking at the meeting praised the hard work of the Finance Board but excoriated legislators for passing a bill triggering a major premium increase. Besides the premium increase, the bill forces public employee spouses who have insurance available where they work to take that insurance or pay a $147-a-month premium.
All health care providers will be paid at 110 percent of Medicare rates, a major boost for hospitals, now paid at about 50 percent of Medicare rates.
March 23, 2023
Medical Cannabis Board meets. Christiansen speaks.
The Medical Cannabis Advisory Board held a brief, virtual quarterly meeting on Thursday. Quick West Virginia cannabis facts presented at the meeting:
23,879 patient applications received for medical cannabis
19,900 approved.
There are nine operational cannabis growers, 44 operational dispensaries and seven operational processors.
130 physicians registered with the program along with 14 active telemedicine companies.
Sales total $36,587,304. 5,334 pounds of medical cannabis sold, numbering 694,561 individual items.
Dr. Matthew Christiansen attended his first meeting as the state’s public health officer. Christiansen said the state must acknowledge the benefit medical marijuana has had for some while realizing marijuana has caused injury to others. Prior to assuming his health officer role, Christiansen headed the state’s Office of Drug Control Policy.
He expressed concern regarding diversion of THC products to youth, particularly through vaping. He said this has caused an uptick in mental health and emergency room visits. He said it is important to counsel pregnant mothers about the risk of cannabis exposure to their unborn fetuses.
PEIA fronts three proposals. Only one specific to legislation
The PEIA Finance Board met Thursday and put forth three proposals for members to consider at a series of public hearings scheduled week. All three proposals, according to the actuaries at the meeting, pull PEIA back into the 80/20 employer/employee split envisioned in the statute. The Finance Board meets March 30 to make its final decision.
Only one specifically lives up to the provisions of SB 268, passed by the legislature and approved by the governor. That hard-fought bill increases PEIA premiums by almost 25 percent. This year’s premium increase is offset by a $2,300 across-the-board pay increase for most public employees.
Option 2 is a blended approach, increasing premiums by 19.2 percent, but increasing medical deductibles and out-of-pocket expenses. Prescription drug deductibles increase by 100 percent. Copays to a primary care provider increase from $20 to $25; specialist copays increase from $40 to $50; inpatient copays increase from $100 to $200; and emergency room visits increase from $100 to $200.
Option 3 includes a 14.6 percent employee premium increase, a medical deductible increase of 50 percent as well as an out-of-pocket increase of 50 percent and an out-of-pocket maximum increase for prescriptions by 100 percent.
March 15, 2023
No major immunization bills pass legislature
West Virginia State Medical Association and its unified allies were able during the just-ended legislative session to fight off nearly a dozen bills weakening the state’s immunization laws. That’s a win in a session mostly consumed by discussion of tax cuts. (The legislature approved a 21.5 percent personal income tax cut already signed by the governor.)
House Health and Human Resources Chair Amy Summers did not hold several meetings of her committee, thus keeping the House exemption bills (One of which she sponsored.) off the House calendar. This was thought more to prevent renegade delegate Brendan Steele from getting any exemption bill passed and less about exemptions.
Troubling is Com. Sub. for
H. B. 3042 - Relating to forbidding excessive government limitations on exercise of religion—known more commonly as RFRA. The House vote was
86-12.House Judiciary Vice-Chairman Tom Fast would not answer questions about the so-called RFRA bill being used as a vehicle to get around mandatory immunizations. He said immunizations would be subject to a nine-step judicial review if an individual believes immunizations infringe upon his or her religious beliefs.
Other delegates were more upfront and said the bill is the vehicle for the courts to stall immunizations.
The bill passed the Senate
30-3 with little debate, and it has been signed by the governor.
PEIA bill passes. Increases premiums.
Another bill causing concern is a major PEIA rewrite. The House of Delegates approved
69-27 SB 268, relating to the Public Employees Insurance Agency. Supporters say the bill, which immediately increases premium payments for PEIA’s 230,00 members by about 25 percent, will keep the plan from insolvency.
Some say the governor may veto the hard-fought legislation. Justice has previously promised PEIA members they would see no premium increase while he is governor. The broken promise could become a major campaign issue if Justice makes a much-speculated run for U.S. Senate.
Opponents say it unfairly raises premiums and will cause a further exodus of employees in a state already strapped for employees to fill often low-paying state jobs. All agree that even with the changes, the state will still need to contribute about $600 million to PEIA during the next four years.
Besides the premium increase, the bill forces public employee spouses who have insurance available where they work to take that insurance or pay a $147-a-month premium. It is unclear how this provision will be enforced.
A $2,300 across-the-board pay increase for most public employees, approved by the legislature and pending in the governor’s office, will, according to supporters, defray the costs of the drastic premium increases. Premiums, which run about $64 a month for employees, have not been increased in 12 years.
All health care providers will be paid at 110 percent of Medicare rates, a major boost for hospitals, now paid at about 50 percent of Medicare rates.
The House made three changes to the bill:
Health care providers in counties contiguous to West Virginia will be reimbursed at the 80/20 rate. Those in non-contiguous counties will be reimbursed at 70/30, adding an additional 10 percent payment to employees seeking care.
To avoid a code conflict, the provisions of SB 577, which places a cap on charges for insulin and diabetes treatment supplies, was added to the bill.
Rampaging anti-vaxxer Del. Brandon Steele got removed from the bill a provision allowing the state health officer to add vaccinations to the mandatory list of vaccinations. (Thought bubble: It is unclear if this is a toothless amendment. The health officer may have this authority in another portion of the code.)
The Senate quickly approved the revised version
26-6.
Physician-endorsed prior authorization bill passes.
The House approved 99-0 with just a title amendment, Eng. Com. Sub. for
S. B. 267 - Updating law regarding prior authorizations. The Senate subsequently approved the House amendment. The Senate had The bill:
Requires PEIA, Medicaid and private insurers develop prior authorization forms that must be electronically submitted. Insurers must respond to prior authorization requests within five business days for routine procedures and two business days for treatment, which, if not received, could jeopardize the life and safety of the patient.
Requires peer-to-peer consultations be held within five business days instead of 30.
Allows a health care provider who has performed an average of 30 procedures a year and in a six-month period during that year received a 90 percent prior approval rating to go for at least six months without requesting a prior authorization.
WVSMA publicly endorsed the bill, issuing a call to action in late February, encouraging members to contact legislators to vote in favor of the bill.
The bill is currently in the governor’s office.
Governor signs DHHR breakup bill
Enrolled Committee Substitute for HB 2006, the long-awaited bill breaking DHHR into three agencies but keeping a single chief operating officer for all three, passed both houses with broad, bipartisan support and is on its way to the governor for his consideration.
Justice vetoed a break-up bill last year, but that was before there was a legislative super-majority that can easily override—with usually only a simple majority required—any of his vetoes. The administration commissioned a million-dollar study following last year’s veto, mostly ignored by legislators, that recommended sweeping changes but keeping the department intact. (Three former DHHR leadership employees, all of who were interviewed for the study, recommended against breakup.)
Insiders predict DHHR retirements will increase (Something a personnel-strapped department doesn’t need) and a year-long scramble for new appointments to the new secretary positions. Veteran observers are saying if career appointees are elevated to the new leadership positions, it will be more of the same, and the reorganization is doomed.
Other bills of interest
Eng.
H. B. 3166 - To permit a hospital to hold an inpatient experiencing a psychiatric emergency for up to 72 hours. This bill passed the Senate 32-0 and passed the House 97-0.
Eng. Com. Sub. for
S. B. 577 - Reducing copay cap on insulin and devices and permitting purchase of testing equipment without prescription
Limits cost-sharing to $35 for insulin and $100 for diabetic supplies.
This bill applies to private insurance companies. PEIA and Medicaid have similar policies already in place.
The bill passed the Senate
32-2. It passed the House
85-12,
