The bill amends the Code of West Virginia to establish payment parity between behavioral health, mental health, and medical/surgical health care providers under the Public Employees Insurance Agency and other health insurance providers. It mandates that reimbursement for mental health care provided by licensed practitioners must be equivalent to that of licensed physicians for similar services, while also prohibiting insurers from reducing physician reimbursements to meet these parity requirements. The legislation emphasizes compliance with federal regulations regarding financial requirements and treatment limitations, ensuring that nonquantitative treatment limitations applied to behavioral health benefits are consistent with those for medical and surgical benefits.

Additionally, the bill introduces new provisions requiring the Public Employees Insurance Agency and the Insurance Commissioner to submit annual reports to the Joint Committee on Government and Finance starting June 1, 2021, detailing compliance with mental health parity laws. These reports must include data on adverse determinations for behavioral health claims and analyses of treatment limitations. The bill also specifies that changes made in the 2025 Regular Session of the Legislature will take effect on July 1, 2026, and establishes that the Insurance Commissioner will enforce compliance with these provisions, including conducting financial examinations of carriers and imposing fines for noncompliance.

Statutes affected:
Introduced Version: 5-16-7, 33-15-4u, 33-16-3ff, 33-24-7u, 33-25-8r, 33-25A-8u
Committee Substitute: 5-16-7, 33-15-4u, 33-16-3ff, 33-24-7u, 33-25-8r, 33-25A-8u