The bill amends the Code of West Virginia to ensure 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 services provided by licensed practitioners must be equal to that of licensed physicians for similar services, contingent upon the submission of appropriate diagnoses and procedure codes. Insurers are prohibited from reducing physician reimbursements to comply with these provisions, thereby ensuring equitable treatment of mental health services in terms of coverage and reimbursement. The bill also outlines specific requirements for claim submissions, emphasizing that insurers cannot impose greater limitations on access to mental health and substance use disorder benefits compared to medical and surgical benefits.

Additionally, the bill requires the Insurance Commissioner to submit annual reports to the Joint Committee on Government and Finance detailing compliance with mental health parity laws, including data on adverse determinations for behavioral health claims and analyses of treatment limitations. It mandates that coverage for behavioral health, mental health, and substance use disorders must be as extensive as that for physical illnesses, and establishes procedures for nonparticipating providers. The bill includes new legal language indicating that changes made in the 2025 Regular Session of the Legislature will take effect on July 1, 2026, and it emphasizes the need for the Insurance Commissioner to adopt legislative rules for compliance reporting. Overall, the bill aims to enhance mental health parity and ensure equitable treatment for individuals seeking mental health care.

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