This bill proposes the addition of a new section, 5-16-7h, to the Code of West Virginia, specifically addressing patient-centered treatment flexibility within the Public Employees Insurance Agency (PEIA). The bill allows patients who have received prior authorization for a covered treatment to opt for an alternative covered treatment for the same diagnosed condition without needing to obtain a new prior authorization. The alternative treatment must be medically appropriate and clinically indicated, and the total cost to the agency for this alternative must not exceed that of the originally authorized treatment.

Furthermore, the bill outlines specific conditions under which the alternative treatment can be covered, including documentation requirements from licensed healthcare providers and verification of cost compliance. It also clarifies that the agency cannot impose new prior authorization requirements or administrative hurdles that would delay access to the alternative treatment. Overall, the intent of the bill is to enhance patient flexibility in treatment options while ensuring that the agency maintains oversight and control over treatment costs and appropriateness.

Statutes affected:
Introduced Version: 5-16-7h