The bill amends the Code of West Virginia by adding a new section, 5-16-7h, which introduces patient-centered treatment flexibility within the Public Employees Insurance Agency. This new provision 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 a new prior authorization. The alternative treatment must be medically appropriate and clinically indicated, and the total cost to the agency for the alternative treatment must not exceed that of the originally authorized treatment.

Additionally, the bill outlines specific conditions under which the agency must provide coverage for the alternative treatment, including documentation requirements from licensed healthcare providers and the agency's authority to verify cost compliance. It also clarifies that the agency cannot require a new prior authorization solely based on a patient's choice of an alternative treatment, nor can it impose unreasonable administrative delays in accessing such treatments. Overall, this legislation aims to enhance patient care by allowing more flexibility in treatment options while maintaining cost controls and oversight.

Statutes affected:
Introduced Version: 5-16-7h
Committee Substitute: 5-16-7h
Engrossed Committee Substitute: 5-16-7h
Enrolled Committee Substitute: 5-16-7h