The 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. Additionally, Medicaid managed care organizations must complete provider credentialing within 60 calendar days of receiving a clean application, with provisions for a one-time extension. The bill also mandates that all enrollment and credentialing applications be submitted electronically, enhancing efficiency in the process.

In conjunction with these new requirements, the bill repeals several sections of the existing law under Chapter 16, which pertained to uniform credentialing for healthcare practitioners. This repeal aims to eliminate duplicative credentialing requirements and streamline the process for Medicaid providers. The Office of the Insurance Commissioner is tasked with prescribing a standard credentialing application form in electronic format, ensuring that the process remains straightforward and user-friendly for providers. Overall, the bill seeks to improve the efficiency and effectiveness of Medicaid provider enrollment and credentialing in West Virginia.

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
Enrolled 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