This bill amends the Code of West Virginia, specifically section 5-16-5, to establish that the Public Employees Insurance Agency (PEIA) shall reimburse healthcare providers at a rate of 110% of the Medicare amount for services rendered. The current law's language regarding the "minimum" level of reimbursement is deleted, and the new language specifies that the reimbursement rate will be set at 110% of the Medicare diagnosis-related group rate for hospital admissions or the Medicare per diem rate for critical access hospitals, as applicable. This change aims to ensure that PEIA maintains competitive reimbursement rates for healthcare services.

Additionally, the bill outlines the responsibilities of the finance board in developing financial plans that ensure fiscal stability for the PEIA. It mandates that all financial plans must be reviewed by an impartial actuary to confirm that they will generate sufficient revenues to cover estimated costs, including incurred but unreported claims. The bill also emphasizes the importance of public hearings and the need for the finance board to consider various factors, such as medical inflation and service utilization patterns, when preparing annual and prospective financial plans. Overall, the bill seeks to enhance the financial management and sustainability of the PEIA while ensuring fair compensation for healthcare providers.

Statutes affected:
Introduced Version: 5-16-5