This bill proposes the addition of a new article to the Code of West Virginia, specifically focusing on the review and transparency of reimbursement rates for substance use disorder services. It establishes legislative findings that recognize substance use disorder as a chronic, treatable condition and emphasizes the importance of regular reviews of reimbursement methodologies to promote transparency and program integrity. The article outlines the purpose of creating a structured process for evaluating Medicaid reimbursement rates, ensuring that evaluations are based on reliable data while supporting access to services and maintaining fiscal responsibility.

The bill mandates the Bureau for Medical Services to employ a data-informed methodology when conducting rate studies for substance use disorder services. It specifies that the review process should consider various factors, including provider costs, workforce expenses, service utilization trends, and geographic considerations. Additionally, the Bureau is required to engage stakeholders in the rate review process and publish findings, including a summary of the rate study, the methodology used, and factors influencing rate adjustments. An annual report must be submitted to the Legislative Oversight Commission on Health and Human Resources Accountability, detailing current reimbursement rates, service utilization trends, access to care indicators, and stakeholder input.

Statutes affected:
Introduced Version: 9-5A-1, 9-5A-2, 9-5A-3, 9-5A-4