Healthcare, West Virginia Legislature

House Health adds PEIA to Senate insulin copay bill, labors over certificate of need exemption bill

MORGANTOWN – The House Health Committee made quick work of approving the Senate’s insulin copay cap bill – with an addition – on Tuesday, but the Senate’s certificate of need exemption bill took a bit more work.

Delegates have been pushing to eliminate certificate of need – CON – for several years and referred to this one as skinny CON repeal, because it contains partial exemptions.

It expands the size of a hospital campus to include everything within 250 yards of a hospital’s main buildings and exempts everything in that space from CON requirements.

It exempts a private physician office with seven or more office practice locations from a CON to acquire and operate a fixed MRI scanner, with the qualification that at least 75% of the scans are for practice patients.

It exempts from CON anyone wishing to acquire, construct, develop or establish a birthing center.

Delegates voted down several proposed amendments; among them one to exempt ambulatory and surgical care centers from CON, one to expand the exempted area from 250 yards to 35 miles, and one to put heart transplants and cardiac surgery back under CON.

The primary argument against the first two was that the bill reflects negotiation and compromise with the Senate – particularly the birth center exemption. And on the third, that heart transplant centers must meet federal guidelines.

Delegate Mike Pushkin, D-Kanawha, wondered what changed this year in the Senate when previous efforts died there. Without naming the senator, he referred to Thomas Memorial Hospital – a WVU Medicine hospital – seeking a CON to buy Pulmonary Associates of Charleston, which sits 176 yards from Thomas.

Senate Majority Leader Tom Takubo, R-Kanawha, is co-founder and partner of Pulmonary Associates. WV News reported Tuesday that Takubo admitted he should have sought a ruling on conflict of interest before voting in favor of the bill. Takubo is WVUM executive vice president of provider relations.

Charleston Area Medical Center is challenging the CON. CAMC and Mon Health System together form Vandalia Health.

Alluding to all of that, Pushkin said, “This is the reason why people don’t trust politicians.”

The committee passed the bill in a show of hands, 11-6, and it heads to the full House.

SB 577 caps the cost of a 30-day supply of insulin at $35, and $100 for devices (a blood glucose test strip, glucose monitor, lancet, lancing device, or insulin syringe; but not insulin pumps). The cost-sharing maximums are aggregate, regardless of quantity or type. A prescription would not be required to obtain a blood-testing kit for ketones.

As it came from the Senate, the bill covered only private insurance and left out PEIA. Senators said PEIA’s copays are very close to those in the bill.

But House Health amended PEIA into the bill. If the full House adopts that amendment and passes the bill that way, it will require Senate concurrence to head to the governor.

The committee passed the bill in a voice vote and it goes to the full House.

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