PEIA Task Force Considers Out-of-State Benefits

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By: Jake Zuckerman, Charleston Gazette-Mail

A Public Employees Insurance Agency Task Force subcommittee inched closer to a final proposal Thursday regarding how much members should pay for care received outside state lines.

Though the Coverage and Plan Subcommittee did not approve a final plan, PEIA Director Ted Cheatham did offer concrete numbers for members to consider.

He said increasing the state’s coverage share for care received out-of-state from 70 percent to 80 percent would cost about $22.4 million per year. That figure also includes a removal of a maximum facility fee and a $25 copay on out-of-state service.

However, he said a new contract between PEIA and a third party vendor could save as much as $9 million over the next year and could help offset the costs.

“It could be less, it could more, depends on what we actually realize in out-of-state discounts,” he said.

At the behest of Sen. Bob Plymale, D-Wayne, a subcommittee member, the group did not vote on the proposal Thursday in order to give Gov. Jim Justice a chance to look the numbers over.

“I think it’s very important that we know where the governor’s office is on this, because I would really not want to take an action here without vetting this in some way with the governor’s office,” he said.

Mike Hall, the governor’s chief of staff and chairman of the task force, said that is probably a wise decision, although the committee has the right to vote regardless of Justice’s opinion.

“It might be prudent to give us a couple of days to digest this and see where his opinion is,” he said.

The issue traces back to how much PEIA members should pay for care if they have to go out of state to receive it, or if it’s more convenient to go out of state to receive it.

“It was made crystal clear in the listening sessions across the state that the out-of-state coverage is one of the leading concerns that the members had,” said Amy Loring, the human resources coordinator and director of staffing and employee relations for Berkeley County schools.

It’s a major issue in the Eastern Panhandle, where Winchester Medical Center in Virginia can sometimes offer more expansive services than in-state providers, and can be a much shorter drive for some West Virginians.

One other proposal Cheatham offered that would require more administrative legwork would be to offer the 80-20 match for Eastern Panhandle PEIA members exclusively, as opposed to other areas in the state. However, he noted as much was just an idea.

“The Eastern Panhandle is a very unique issue. We have tried to fit one peg into all the holes, and it doesn’t fit well in the Eastern Panhandle,” Cheatham said.

The committee also discussed possibilities to reduce the cost of prescription drugs for members. The committee is considering allowing members to seek waivers that would qualify them for cheaper tier-2 drugs, as opposed to tier-3 options, which would cost about $2 million per year.

The group last met Oct. 29, where it discussed the same issues. It also adopted a recommendation for its final report, calling on PEIA to negotiate in-state rates for doctors who have offices in West Virginia and in out-of-state border counties.

Justice created the task force via an executive order at the high watermark of the statewide teacher and school service personnel strike earlier this year.