This bill aims to enhance mental health parity in West Virginia by requiring the Public Employees Insurance Agency and other health insurance providers to offer coverage for behavioral health, mental health, and substance use disorders that is equivalent to coverage for medical and surgical procedures. It introduces a new section in the West Virginia Code, specifically 5-16-7h, which outlines definitions, coverage requirements, and compliance measures for mental health services. The bill mandates annual reporting to the Joint Committee on Government and Finance, detailing compliance with parity standards and the processes used to determine medical necessity for both mental health and physical health services.

Additionally, the bill establishes provisions for nonquantitative treatment limitations, ensuring that restrictions on mental health benefits are not more stringent than those applied to medical benefits. It requires insurance carriers to communicate clearly regarding coverage denials and the rights of covered persons, including access to medical necessity criteria. The Insurance Commissioner is tasked with submitting annual reports starting June 1, 2025, detailing compliance with parity standards, including data on adverse determinations for mental health claims. The provisions of this bill will take effect for policies and contracts beginning on or after January 1, 2026.

Statutes affected:
Introduced Version: 5-16-7h, 33-15-4y, 33-16-3ii, 33-24-7z, 33-25-8w, 33-25A-8z