The bill seeks to amend the Code of West Virginia to establish mental health parity in health insurance coverage, ensuring that benefits for behavioral health, mental health, and substance use disorders are provided on equal terms with medical and surgical benefits. It mandates that health insurance providers, including the Public Employees Insurance Agency, offer coverage for prevention, screening, and treatment of these disorders that is no less extensive than that for physical illnesses. Key provisions include compliance with nonquantitative treatment limitations, the requirement for coverage of behavioral health screenings, and the establishment of procedures for treatment authorization with nonparticipating providers. Additionally, any denial of reimbursement must include specific language informing covered persons of their rights.

The bill also requires the Insurance Commissioner to submit an annual report starting June 1, 2026, detailing compliance with these parity requirements, including data on adverse determinations for mental health claims and analyses of medical necessity criteria. The report must ensure that nonquantitative treatment limitations are applied comparably across both mental health and medical benefits. The provisions of this bill will take effect for policies and contracts beginning on or after January 1, 2027, and the Insurance Commission is tasked with proposing legislative rules to implement these changes.

Statutes affected:
Introduced Version: 5-16-7h, 33-15-4y, 33-16-3ii, 33-24-7z, 33-25-8w, 33-25A-8z