Legislature May Require Government-Paid Doctors to Accept Medicaid

Two bills aimed at expanding access to health care in the territory and a third requiring background checks were sent out of committee Wednesday.

Bill 31-0294, sponsored by Sen. Nereida Rivera-O’Reilly, would require health care providers to accept Medicare and Medicaid who are employed by the V.I. Government and who are engaged in private practice and receive financial assistance toward the payment of medical malpractice insurance premiums.

Sen. Kurt Vialet sponsored the two other approved bills, which would expand the circumstances under which medical practitioners can get temporary licensure in the territory and require the various medical licensing boards, from dentistry to naturopathy, to perform criminal background checks on license applicants.

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Rivera-O’Reilly said too many Virgin Islanders who depend on Medicare and Medicaid for health insurance are forced to go off-island for care, which can be a tremendous hardship or financially impossible for many, causing suffering and harm for "the least of us."

Not only is it a hardship, she said, but it also means millions in federal dollars go right out of the territory, when it could be spent here. Rivera-O’Reilly first introduced the measure in the 30th Legislature, but said it was appropriate to hear it now because the Medicaid roles have increased from 5,000 to almost 20,000 Virgin Islanders, thanks to the federal government’s Medicaid expansion through President Barack Obama’s Affordable Care Act.

Schneider Regional Medical Center Chief Executive Officer Bernard Wheatley testified against the change, arguing it would make it that much harder to attract physicians to work in the V.I. hospitals.

"This bill as proposed penalizes the physicians who work for the hospital and does nothing to affect the other physicians who practice in the territory. It puts hospital employed physicians at a disadvantage and disincentives physicians from working at the hospital," Wheatley said.

Acting Health Commissioner Michelle Davis said the goal of the bill was worthwhile, but that Health had "concerns regarding tying medical provider participation in a program designed to reduce risk and exposure for provision of care to both of these programs."

She also said only three providers in the USVI are officially not participating in Medicare, while 272 are participating.

Dynel Soto, a director of V.I. Equicare, said the barrier to more doctors accepting Medicaid may be a bureaucratic one within Human Services, rather than reluctance on the part of doctors.

Soto said her company entered into an agreement with Human Services in 2013 to credential providers for Medicaid and other programs. But that agreement expired a year ago and she said, to the best of her knowledge, Human Services has not enrolled any new providers since then.

Human Services Commissioner Vivian Ebbesen-Fludd acknowledged the department "has challenges with provider enrollment" but is working with a new contractor and considering ways to ease the process. She said that during Fiscal Year 2013, Human Services had 139 Medicare providers, but now had 419, as it ramped up along with the Medicaid expansion.

"DHS is not perfect; however, we are exerting all our energies at every level to improve our services (in a) department that has been long neglected in regards to human resources and financial resources," she said.

Vialet’s bill [Bill 31-0324] to allow medical practitioners in private practice to apply for temporary licensure in the territory had supporters and opponents. Private practitioners and Dr. Anthony Ricketts, who works with Gov. Juan F. Luis Hospital, testified in support, saying there was an urgent need for more specialists and for temporarily licensed physicians who could take over when a doctor goes on vacation.

Hospital and Health Department officials testified against the measure, arguing it would pull money away from the hospitals and into private practice and take away from the hospitals an advantage in attracting physicians when they are already struggling to attract them.

Vialet’s measure [Bill 31-0305] requiring police background checks met little opposition.

All three bills were approved unanimously. Several amendments are being prepared to address concerns raised by the testifiers, which Vialet said would be considered when the bills are heard in the Rules and Judiciary Committee.

Voting yes on each bill were: O’Reilly; Vialet; Sens. Marvin Blyden; Jean Forde; Novelle Francis; Justin Harrigan and Almando "Rocky" Liburd.

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