Health Insurance

Legislative Lookahead: PEIA, DHHR reform on the front burner for lawmakers | Journal-news

CHARLESTON — Legislative leaders all agreed Friday that reform of the West Virginia Department of Health and Human Resources and how the state’s health insurance program for public employees reimburses health care providers are high priorities for the 2023 legislative session next week.

Reporters heard ideas on these and other issues Friday during the West Virginia Press Association’s annual Legislative Lookahead at the Culture Center in Charleston.

DHHR has been in the headlines over the last several years as the state’s substance abuse crisis rages on, the number of children in foster care remains high and West Virginia sits on multiple national lists for bad health care outcomes.

Senate President Craig Blair, R-Berkeley, said there would be a bill offered early in the 2023 legislative session beginning Wednesday to split DHHR into three separate departments. Blair said the bill would be one of many aimed at fixing DHHR’s systemic issues.

“That will be the beginning of the phased changes if we’re able to do that,” Blair said. “There’s a lot of good ideas that’s out there that can make this happen. They’re coming in on a daily basis.”

The Legislature passed a bill last year to split DHHR into a new Department of Health and Department of Human Resources. That bill was vetoed by Gov. Jim Justice. House Minority Leader Doug Skaff, D-Kanawha, said he’s not sure whether splitting DHHR is the best move, but he believes it is important to have the conversation.

“We don’t know the right answer, but we have to talk about it, alternatives and opportunities to do something differently because what we’ve done now hasn’t worked,” Skaff said. “I don’t know what the right answer is. Do you divide it up? Do you divide it into three and four things? Do you move different pieces of it into other departments? Who knows? But we need to talk about it. We need to make changes. We need to move forward.”

Instead of splitting up the department, Justice ordered DHHR to contract with a third party for a top-to-bottom review of the department.

DHHR awarded a contract to the Virginia-based McCrystal Group for more than $1 million to conduct an organizational assessment and strategic plan for DHHR. The McCrystal report, released in November, recommended adding three new deputy DHHR secretaries, creating integration teams to help with better communication within DHHR and with stakeholders and realigning its support structure. But the lawmakers have expressed disappointment in the limited scope of the report.

The Legislature’s Joint Committee on Government and Finance — led by Blair and House Speaker Roger Hanshaw, R-Clay — hired former DHHR Deputy Secretary Jeremiah Samples in May to help lawmakers formulate a reform plan for DHHR. Samples, who began his career at DHHR in 2006, served as deputy secretary under Secretary Bill Crouch from 2017 to April, when Samples left citing differences of opinion with the direction the department was going in.

“Jeremiah Samples was respected by the House, the Senate, Republicans and Democrats … he was the go-to guy to be able to get the information,” Blair said. “He’s a tremendous resource for the State of West Virginia, so we hired him for the joint committee. Right now, he’s helping develop the path forward, along with many others, so that we make the right decisions.”

Earlier this week, Blair released a letter he wrote to Dr. Jeff Coben, the interim cabinet secretary for DHHR, laying out a number of reforms for the state foster care system and Child Protective Services developed by Samples. Ideas include regional pay differentials for border counties to compete for CPS workers in neighboring states, assigning CPS workers by county population and developing predictive tools to help keep families together before there is a need to separate children from families.

Coben has already initiated some changes, including hiring additional CPS workers for the Eastern Panhandle, instituting hiring bonuses for counties where there are shortages of CPS workers, allowing retired DHHR employees to return to work on a limited basis to help fill positions and lifting a hiring freeze put in place by Crouch.

“I do applaud the recent changes that the executive has made already in bringing some additional light and some additional clarity and focus to DHHR,” Hanshaw said. “That needs to continue at the level of the (governor). It needs to continue at the level of the Legislature. We expect to act on that in some way very seriously this legislative session.”

DHHR is the state’s largest department, with a $7.5 billion budget made up of state and federal funding and more than 4,900 full-time employees. Hanshaw said some of the reforms will come from looking at how DHHR spends money and its processes.

“There’s an incredible amount of resources there dedicated to caring for the most vulnerable West Virginians,” he said. “We have to make sure that we’re using those resources correctly, that we’re not being irresponsible with them, and that we’re making sure that the resources we deploy and the structure that we’ve put in place to deploy them is sufficient.”

Legislative leaders also talked about the Public Employees Insurance Agency. Wheeling Hospital announced Thursday that it would stop accepting PEIA effective July 1, citing extremely low reimbursement rates for in-state hospitals compared to out-of-state hospitals.

Passed last year, Senate Bill 574 would have split PEIA into state employee and non-state employee plans. It would also have required reimbursement for any hospital and emergency medical services for PEIA beneficiaries at a rate of 110% of similar services offered by Medicare.

The bill was never taken up by the House of Delegates, but Blair said it would be re-introduced and passed early in the session.

“Who didn’t see this coming? We did in the Senate. We passed a bill last year,” he said. “If we don’t do something fairly quickly on that, that is going to be contagious… you’re going to see other hospitals and providers stop taking PEIA, and that cannot happen.”

Skaff said the state needs to use the substantial tax revenue surplus to invest in PEIA and shore up its finances. PEIA has avoided premium increases over the last several years, but long-term financial forecasting shows the health plan running into increased costs.

“We all agree that PEIA must be a priority,” Skaff said. “We have the money now to do it, to invest in PEIA. Just think, if you set aside $100 million and you don’t do anything with it and you collect a 5% interest rate every year, that’s a good chunk of money that you would get every year. We could use that money year after year.”

Steven Allen Adams can be reached at [email protected].