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 care provided by licensed practitioners must be equivalent to that of licensed physicians for similar services, provided claims are submitted with the appropriate diagnoses and procedure codes. Insurers are prohibited from reducing reimbursement amounts to comply with these provisions, ensuring equitable treatment of mental health services in terms of coverage and reimbursement. The bill also outlines specific requirements for claim submissions and emphasizes that insurers cannot impose greater limitations on access to mental health and substance use disorder benefits than those applied to medical and surgical benefits.

Additionally, the bill requires the Insurance Commissioner and the Public Employees Insurance Agency 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 demonstrating that treatment limitations are applied comparably across both behavioral and medical benefits. The bill also introduces new language stating that changes made in the 2025 Regular Session will take effect on July 1, 2026, and emphasizes the importance of maintaining consistent reimbursement rates for licensed mental health practitioners. Overall, the bill aims to enhance access to mental health care by ensuring equitable treatment and reimbursement practices across different types of health care services.

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