West Virginia House Bill HB2130

West Virginia 2025 Regular Session

• Introduced: 2/12/25
• Refer: 2/12/25

Caption

Relating to setting the rate the Public Employees Insurance Agency shall pay for services

Summary

HB2130 amends the Public Employees Insurance Act to require the Public Employees Insurance Agency (PEIA) financial plans to establish a minimum reimbursement level of 110 percent of the Medicare amount for all providers. For West Virginia hospitals providing inpatient care, the bill sets a minimum payment of 110 percent of the Medicare diagnosis-related group rate, or the Medicare per diem rate for critical access hospitals, as applicable. The bill states that these reimbursement requirements do not apply to Medicare primary retiree health plans. The measure also retains and reinforces the existing PEIA financial planning structure, including actuarial review, annual and prospective financial plans, public hearings, and limits on how costs are shared between employers and employees. It continues the requirement that PEIA plans be designed to maintain fiscal stability, with an 80/20 employer-employee premium cost-sharing framework referenced in the bill, and it preserves the board’s authority to use cost-containment measures, subsidize retiree coverage, and retain surplus revenues for future premium stabilization.

Impact

If enacted, HB2130 would directly change the reimbursement floor PEIA must use when paying providers, increasing the statutory minimum payment rate to 110 percent of Medicare for covered services and hospital inpatient care. That would affect PEIA, participating employers, employees, retired employees, and health care providers, especially hospitals and other providers reimbursed under PEIA plans. The bill also narrows the board’s flexibility by embedding this payment standard in the financial plan requirements while leaving the broader actuarial planning and premium-setting framework in place.

Sentiment

Based on the bill text and the absence of recorded committee testimony or votes, the available context suggests the bill is framed as a policy directive to increase provider reimbursement rather than as a broad restructuring of PEIA. The sponsor’s stated purpose is clear and targeted: to establish a 110 percent Medicare payment rate. Because there are no transcripts or vote records provided, there is no documented public debate in the supplied materials showing support or opposition, but the language indicates a likely interest in improving provider payments and network participation.

Contention

The main point of contention is likely the cost of raising PEIA reimbursement rates. Supporters would likely view the bill as a way to improve access to care, strengthen provider participation, and better compensate hospitals and other providers. Opponents or fiscal skeptics would likely focus on the potential for higher PEIA spending, pressure on premiums, and possible effects on employer and employee cost-sharing. Another possible issue is the bill’s interaction with existing PEIA budgeting authority, since it limits flexibility by mandating a specific reimbursement floor while PEIA is otherwise tasked with maintaining actuarial balance.