The bill amends the West Virginia Code to improve the prior authorization process for medical services and medications by requiring the Public Employees Insurance Agency (PEIA) and the Bureau for Medical Services (BMS) to implement an electronic portal for submitting prior authorization requests. This portal will include detailed information on required authorizations, submission instructions, and request status notifications. The bill mandates timely responses to these requests, particularly for urgent medical situations, and allows for a three-month carryover of approved prior authorizations across managed care organizations. Additionally, it introduces a peer review process for denied requests and clarifies that pharmaceutical medications are excluded from the prior authorization gold card process.

Moreover, the bill establishes a "gold card" system for healthcare practitioners with high approval ratings, allowing them to bypass prior authorization requirements for a specified period. It also outlines the appeal process for denied requests, requiring peer reviews by practitioners of similar specialties. The Insurance Commissioner is tasked with collecting data to ensure compliance with these new regulations, which include civil penalties for violations. These provisions are set to take effect for policies beginning on or after January 1, 2024.

Statutes affected:
Introduced Version: 9-5-32, 33-25A-8s
Committee Substitute: 5-16-7f, 9-5-32, 33-15-4s, 33-16-3dd, 33-24-7s, 33-25-8p
Enrolled Committee Substitute: 5-16-7f, 9-5-32, 33-15-4s, 33-16-3dd, 33-24-7s, 33-25-8p