This bill amends the Code of West Virginia by introducing a new section, 9-5-34, which establishes expedited enrollment timelines for Medicaid providers and a uniform credentialing requirement for managed care organizations. By July 1, 2026, the Department of Human Services or its agent is required to complete enrollment determinations for Medicaid providers within five business days of receiving a completed application. The bill mandates that the enrollment process be conducted electronically, allowing multiple users to access the system, and requires that applicants be notified of any incomplete documentation within two business days. Additionally, Medicaid managed care organizations must complete provider credentialing within 60 calendar days of receiving a complete application, with provisions for a one-time extension and penalties for failure to meet these timelines.

The bill also repeals several sections of the existing law related to uniform credentialing for health care practitioners, specifically Articles 16-1A-1 through 16-1A-10. This repeal indicates a shift towards a more streamlined and electronic approach to credentialing and enrollment processes for Medicaid providers, as the new provisions aim to simplify and expedite these procedures. The Office of the Insurance Commissioner is tasked with prescribing a standard electronic credentialing application form, ensuring that the process remains straightforward and user-friendly for providers.

Statutes affected:
Introduced Version: 9-5-34, 16-1A-1, 16-1A-2, 16-1A-3, 16-1A-4, 16-1A-5, 16-1A-6, 16-1A-7, 16-1A-8, 16-1A-9, 16-1A-10
Committee Substitute: 9-5-34, 16-1A-1, 16-1A-2, 16-1A-3, 16-1A-4, 16-1A-5, 16-1A-6, 16-1A-7, 16-1A-8, 16-1A-9, 16-1A-10
Engrossed Committee Substitute: 9-5-34, 16-1A-1, 16-1A-2, 16-1A-3, 16-1A-4, 16-1A-5, 16-1A-6, 16-1A-7, 16-1A-8, 16-1A-9, 16-1A-10