The bill amends the Code of West Virginia by introducing a new article focused on establishing a value-based payment model for addiction care recovery outcomes. It aims to address the ongoing issues of substance use disorder and overdose deaths in the state by reorganizing the addiction care system into a value-based continuum of care. The article outlines the legislative intent, defines key terms, and sets forth the establishment of value-based measures, including timelines for implementation and the authority of the Bureau for Medical Services. It emphasizes the need for coordination, integration, and accountability in recovery success, while also mandating the collection and analysis of performance data to improve quality in the Medicaid program.

Key provisions include the establishment of standard billing codes for substance use disorder services, the development of outcome-based performance measures, and the requirement for managed care organizations to implement value-based payments by July 1, 2028. The bill also stipulates that the Bureau for Medical Services must submit a state plan amendment to the Centers for Medicare and Medicaid Services (CMS) to facilitate the necessary payment and coverage changes. Notably, the provisions of this article will not take effect unless CMS approves the state plan amendment, ensuring that the implementation of the value-based payment model is contingent upon federal approval.

Statutes affected:
Introduced Version: 16-67-1, 16-67-2, 16-67-3, 16-67-4, 16-67-5
Committee Substitute: 16-67-1, 16-67-2, 16-67-3, 16-67-4, 16-67-5
Committee Substitute for the Committee Substitute: 9-11-1, 9-11-2, 9-11-3, 9-11-4, 9-11-5, 9-11-6
Enrolled Version: 9-11-1, 9-11-2, 9-11-3, 9-11-4, 9-11-5, 9-11-6