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Monday, September 26, 2022

West Virginia Legislature Blog

Interim Report: Committee on PEIA, Seniors and Long Term Care

Jason Haught, PEIA interim director and chief financial officer, briefed the committee on the agency’s most recent finance board meeting as well as general topics, during Sunday afternoon’s interim meeting at the Capitol.

Haught explained to members that PEIA expenses continue to outpace current budgets. He noted that if nothing changes between now and the first quarter of next year, PEIA will need a 12 percent premium increase in 2024 for the non-state fund and a $56 million increase for the in-state fund. Haught noted that the $56 million would likely come from the PEIA rainy day fund.

Haught explained how, in the past, West Virginia and in-state providers have agreed to accept PEIA rates as a “reciprocal agreement to provide incentive for higher in-state carrier utilizations and savings to the taxpayer.”

According to Haught, PEIA reimburses out-of-state providers based upon the United Healthcare National Network Rate. All out of state care, with the exception of border counties, must have prior approval.

A PEIA member who seeks treatment out-of-state without prior approval is responsible for 30 percent of the cost, as opposed to 20 percent for in-state treatment.

Jim Kaufman, CEO of the West Virginia Hospital Association and Jody Ratliff, from Emergency Medical Services also spoke to the committee regarding PEIA rates.

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