This bill establishes a value-based payment system for West Virginia's Medicaid addiction care services, shifting from fee-for-service to rewarding providers based on patient recovery outcomes. It directly affects Medicaid providers treating substance use disorders by requiring them to use standardized billing codes starting in 2027 and report on five specific outcome metrics: housing stability, sobriety, avoidance of criminal justice involvement, self-sufficiency (employment/education), and provider transition plans. The bill mandates data collection and analysis by the Bureau for Medical Services to develop these metrics, with value-based payments requiring implementation by 2028. The goal is to create a coordinated care system focused on long-term recovery success rather than fragmented service volume.
SB 650 amends West Virginia law to define a psychiatric hospital treating exclusively civil and forensic patients (with over 95% of its inpatient census being court-ordered forensic or civil involuntary commitments from state custody) as a "state-designated facility" for tax purposes. This change excludes such hospitals from the category of "eligible acute care hospitals" subject to a 0.75% tax on gross receipts, exempting them from this tax. The bill directly affects psychiatric hospitals in West Virginia meeting this specific patient mix requirement by altering their tax classification under the Medicaid funding structure.
West Virginia Senate Bill 645 prohibits non-network ambulance services from charging patients extra fees beyond standard insurance cost-sharing. It requires insurers to pay non-participating ambulance providers directly at 400% of the Medicare rate (or the provider’s billed amount, whichever is lower) within 30 days of a clean claim. Patients cannot be billed for amounts beyond their standard copayments, coinsurance, or deductibles, and insurers must provide written denial notices with specific reasons. This applies to ground ambulance services covered under health insurance policies issued on or after January 1, 2027.
This bill (SB 570) allocates $199,476,099 in unspent federal funds to the West Virginia Department of Health's "Rural Health Transformation Program" for fiscal year 2026. It adds a new funding line (Fund 8802, Org 0506) under the Department's Central Office to support this specific program. The funds are designated for rural health initiatives and directly affect the Department of Health's ability to implement these programs. This is a procedural funding measure, not a policy change, using existing federal funds without new tax implications.
HB 5074 changes how revenue from West Virginia's medical cannabis program is allocated. For fiscal year 2026, it directs $3 million to the Supreme Court for a child protection pilot, $10 million each to West Virginia University and Marshall University for ibogaine research, and $5 million to homelessness services, with remaining funds reverting to general revenue. Starting July 1, 2026, annual allocations will be: 15% to the Medical Cannabis Bureau for administration, 15% to the Department of Agriculture for cannabis testing, and 45% split among the Fight Substance Abuse Fund (20%), university research (10% each to Marshall and WVU), a Child Protection Commission (10%), and law enforcement training programs (40%). These changes apply to ongoing revenue from medical cannabis taxes, not new taxes or fees.
SB 649 requires West Virginia Medicaid to cover home blood pressure monitoring devices for specific enrollees: pregnant individuals or those within 12 months postpartum who have been diagnosed with uncontrolled hypertension. The bill mandates that covered devices must be validated by the U.S. Blood Pressure Validated Listing and includes coverage for an extra blood pressure cuff. Medicaid providers must also receive reimbursement for related services, such as patient training, interpreting readings, and delivering co-interventions. This policy directly affects Medicaid recipients with hypertension during pregnancy or postpartum, expanding access to essential monitoring tools.
HB 5260 adds "edible" as an allowable form of medical cannabis in West Virginia, with strict requirements for safety and regulation. It requires processors to obtain bureau approval for each edible product, mandates specific shapes (like squares or circles), limits edibles to lozenges or gelatins, and caps THC content at 10mg per serving with a 15% potency variance. The bill prohibits color additives in edibles and requires all medical cannabis dispensing to be reported to the state's controlled substance monitoring database. This directly affects patients using medical cannabis, caregivers, and licensed processors who must comply with these new edible-specific rules.
HB 5413 creates a Central Abuse Registry managed by the West Virginia State Police to track individuals convicted of abuse, neglect, or misappropriation of property involving children, incapacitated adults, or adults receiving behavioral health services in specific settings like residential care facilities, day care centers, or home care. It requires registrants to provide personal details (name, DOB, SSN) and pay an annual $125 fee to the circuit clerk, with fees funding mental health services for State Police employees. The registry combines existing requirements, so those already registering as sex offenders only pay one $125 fee instead of separate fees. Failure to pay the fee does not violate supervised release, but unpaid fees may result in a recorded judgment lien.
HB 4981 designates psychiatric hospitals treating exclusively civil and forensic patients (over 95% court-ordered civil/forensic cases from state custody) as "state-designated facilities" for Medicaid funding purposes. This change allows these specific hospitals to qualify for Medicaid reimbursement under federal rules, rather than being excluded as "state-designated" under current tax code. The bill amends tax provisions to ensure revenue collected from eligible hospitals (via a 0.75% tax on gross receipts) flows directly into a Medicaid funding account. It directly affects licensed psychiatric hospitals meeting the strict patient-mix criteria, enabling them to access Medicaid program funds they previously could not.
HB 5096 removes the requirement for state approval (a "certificate of need") for two specific healthcare services in West Virginia: personal care services and intellectual developmental disabilities (IDD) services. This means healthcare providers offering these services no longer need prior state permission before expanding or establishing them. The bill amends existing law (§16-2D-10) to explicitly exempt these services from the certificate of need process, which previously applied to many healthcare expansions and facility changes. This change directly affects providers of personal care (like assistance with daily living activities) and IDD services (such as support for individuals with developmental disabilities), streamlining their ability to operate without state review.
