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 equal to that of licensed physicians for similar services, contingent upon appropriate claims submissions. Insurers are prohibited from reducing physician reimbursements to comply with these provisions, and they must adhere to federal regulations regarding financial requirements and treatment limitations for behavioral health services. The bill also outlines specific requirements for claim submissions, ensuring that no nonquantitative treatment limitations are applied to behavioral health benefits that are not also applied to medical and surgical benefits.

Additionally, the bill requires 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 demonstrating consistent application of medical necessity criteria across behavioral and medical benefits. The legislation emphasizes that coverage for behavioral health, mental health, and substance use disorders must be as extensive as that for physical illnesses, and it empowers the Insurance Commissioner to enforce compliance through financial examinations of carriers. Notably, any changes made to this article in the 2025 Regular Session of the Legislature will take effect on July 1, 2026.

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