The bill seeks to amend the Code of West Virginia to establish payment parity between behavioral health, mental health, and medical and 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 equivalent to that of licensed physicians for similar services, contingent upon the submission of appropriate claims. The bill also prohibits insurers from reducing physician reimbursements to meet these parity requirements and requires compliance with federal regulations regarding financial requirements and treatment limitations for mental health and substance use disorder benefits. Additionally, it outlines eligibility criteria for providers, claim submission requirements, and emphasizes that nonquantitative treatment limitations for behavioral health benefits must align with those for medical and surgical benefits.

Moreover, the bill introduces specific provisions for coverage of behavioral health, mental health, and substance use disorders, ensuring that such coverage is at least as extensive as that for physical illnesses. It requires insurance carriers to authorize treatment with nonparticipating providers when necessary and mandates compliance with federal regulations regarding treatment limitations. The Insurance Commissioner is tasked with submitting annual reports to the Joint Committee on Government and Finance starting June 1, 2021, detailing compliance with mental health parity laws, including data on adverse determinations and analyses of treatment limitations. Notably, the bill includes a provision stating that changes made in the 2026 Regular Session of the Legislature will take effect on July 1, 2027.

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