The proposed bill aims to amend the Code of West Virginia by introducing a new article focused on value-based payment requirements for addiction care recovery outcomes. It recognizes the ongoing challenges posed by substance use disorder in the state and seeks to reorganize the addiction care system into a value-based continuum of care. This includes establishing definitions for key terms such as "continuum of care" and "value-based payment," which emphasizes rewarding providers for quality care and penalizing them for not meeting specific metrics. The bill outlines the responsibilities of the Bureau for Medical Services, including the establishment of standard billing codes, data collection for analysis, and the development of outcome-based performance measures by July 1, 2026.

Additionally, the bill sets timelines for the implementation of a value-based payment model, requiring the Bureau for Medical Services to implement a baseline year by July 1, 2027, and to require Managed Care Organizations to conform to the new payment structure by July 1, 2028. It also mandates the submission of a report to the Legislative Oversight Commission on Health and Human Resources Accountability, detailing substance use disorder trends and outcomes. The bill emphasizes the importance of developing a payment model that incentivizes positive health outcomes while ensuring compliance with federal regulations. Overall, the legislation aims to enhance the effectiveness of addiction treatment and recovery services in West Virginia.

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