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PEIA looks at border issues, drug coverage

CHARLESTON — A subcommittee of the task force looking at how to reform the Public Employees Insurance Agency has the unenviable job of looking at ways to improve health plans to save money but also deliver the services public employees expect.

The Coverage and Plan Subcommittee of the PEIA Task Force met Monday morning in the House Government Organization Committee room at the State Capitol Building in Charleston.

The group is one of three subcommittees trying to fulfill Gov. Jim Justice’s mandate to find ways to provide long-term financial stabilization to the program that up to this time last year was suffering from the increase in health care costs nationwide.

The subcommittee looked at some of the issues plan members brought up during 21 public meetings held across the state over the summer. The Public Outreach Subcommittee compiled all the comments from those meetings and a survey and presented that report to the full task force Aug. 8.

One of the concerns brought up in the public outreach summary was issues affecting PEIA plan participants in border counties. Ted Cheatham, the director of PEIA, explained that the state sets maximum facility fees for common services, such as imaging, lab work, and colonoscopies. A service that might be covered at a West Virginia hospital or doctor’s office could cost a plan participant more if they go across the border for the same service.

According to Cheatham, the state has already seen $3.6 million in savings to PEIA from people staying in West Virginia for medical services since the fees were put in place

“We want people to come into state,” Cheatham said. “We want people to use West Virginia facilities. We believe the fees are adequate and we believe it’s a good program.”

Cheatham said that there are plenty of in-state locations for plan participants to receive those common medical services, but he understands some medical procedures can’t be done in-state. Cheatham said public employees who work on the borders of Virginia, Kentucky, Ohio, Pennsylvania, and Maryland might have to drive further in-state for simple procedures.

“Do they have to drive another 20 minutes? Potentially yes. Is it worth $1,000 to the plan and to the member to drive that distance? That’s for them to decide,” Cheatham said.

The places where most plan participants go out-of-state for procedures is Winchester Medical Center, which serves Eastern Panhandle residents, as well as the Cleveland Clinic. Cheatham said he understands that there are some things that can be done at Winchester that can’t be done in the Eastern Panhandle, but the same can’t be said for participants near Huntington, Parkersburg, or Morgantown. Cheatham said there is some hesitancy for residents in the Beckley/Bluefield area to go to Charleston Area Medical Center due to tolls, even though PEIA reimburses for tolls and mileage.

“Everyone we serve is either an employee of the state or has been an employee of the state,” Cheatham said. “They’re getting state dollars and I believe state dollars should be used in the state to help our facilities, our hospitals, and our technology if it can be done in this state. They drive into this state to work, why can’t they drive into this state to receive quality healthcare.”

The subcommittee passed a motion recommending that PEIA address the issues regarding different charges for doctors who practice on both sides of the state border but are willing to take PEIA rates.

Switching to the topic of prescription drugs, the Public Outreach Subcommittee report said that plan participants want PEIA to consider options for public employees and retirees who need specific brands of medications and look at ways to handle PEIA’s 90-day prescription supply policy.

Geoff Christian, a member of the PEIA Finance Board, said plan participants need better educated about the resources PEIA has for helping them with high-cost prescriptions, such as flexible spending accounts that allow people to save back money pre-tax to pay for medications that expensive.

“Process is what is intimidating. I don’t think the employees ‒ those who are covered – understand that process,” Christian said. “Are they being educated enough that they have an FSA that’s available to them?”

Christian said that PEIA needs more opportunities to educate members about the plans and the resources. While PEIA does travel around the state to educate public employees and retirees on proposed plan changes, Christian said perhaps a more personal education initiative would help workers.

“What we’re seeing now with different pressures on families, we need different avenues where they can also learn the plans,” Christian said. “We’re talking about big numbers and costs, but there are tools and things that are set in place where you can budget for those items pretty easily.”

Cheatham also announced he was meeting with the governor Wednesday on a new idea to save $5 million but told subcommittee members he couldn’t say much more than that due to proprietary reasons. Earlier this month, Justice announced his intentions of putting $100 million in PEIA for long-term stabilization.

The PEIA Task Force was formed in March by Justice to find ways to fix the state employee health insurance program.

The task force will come up with a plan to fix PEIA in December, but the two remaining subcommittees are expected to complete their work in November.

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