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Bill to reduce Medicaid costs cut up in Senate committee

CHARLESTON, W.Va. -- A West Virginia bill intended to streamline the way Medicaid patients get to the doctor's office would be more difficult to manage and less effective after amendments made by a state Senate committee Thursday.

The state reimburses Medicaid members for costs related to getting to the hospital for non-emergency services, whether they drive themselves, get a ride from a senior center, take a bus or take an ambulance. State rules dictate that the least expensive option must be used.

The state spends about $25 million per year on the services. It was hoped that this bill would save $5 million.

The bill proposed by Gov. Earl Ray Tomblin would create a broker that would guide Medicaid patients toward the most convenient and least expensive option. But the Senate Health and Human Resources Committee voted unanimously to exempt ambulances, public transit and senior centers from being managed by the broker system. The exemptions mean that instead of calling one central phone number and being guided toward the best option, Medicaid patients will have to navigate the options on their own and may end up choosing a more expensive one.

The state currently reimburses people who drive themselves or get a ride from a family member at a rate of 47 cents per mile. Medicaid reimburses ambulances at about $140 for non-emergency trips.

The committee heard from representatives from ambulance companies and public transit who feared that they would lose business if they were managed by a broker.

Chris Hall of the West Virginia EMS Coalition told the committee that EMS services in the state are entirely dependent on the fees they receive from non-emergency trips. Hall said that the fees from those trips subsidize emergency ambulance services throughout the state.

"We don't dispute that there's some problems in the non-emergency transport program with Medicaid," Hall said. "Our concern is that right or wrong we do not have any other funding services for those ambulances so we do rely on those non-emergency transports."

J. Douglas Carter is the manager of the public transportation systems in Hampshire, Hardy, Grant, Mineral and Pendleton counties. He said they have done 20,000 non-emergency medical trips in the last eight months and called them the lifeblood of the public transportation system.

"When a brokerage comes in they limit trips and they cut reimbursement rates dramatically and what ends up happening over a period of time is operations like ours, public transit, we are forced to abandon that service because of pricing and limitations," Carter said. "We will not be able to continue to function if a brokerage comes in."

Cindy Beane, a deputy commissioner in the state Department of Health and Human Resources, said that the broker would not damage the service providers as much as they thought it would. Beane said that carving out exemptions for specific providers would make the program unwieldy.

"It would be difficult to manage with all the exemptions, I think it would be difficult for the member to know how to navigate the system," Beane said. "It's less effective than managing the entire program."

The bill also attempts to crack down on fraud from patients who abuse the reimbursements for rides from friends and family.

A spokeswoman for Tomblin said that they had not yet reviewed the amended bill so could not comment on the changes.


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