Healthcare

in committee · West Virginia · Senate Jan 21, 2026

SB 565: Requiring PEIA and other health insurance providers to provide payment parity for certain services

SB 565 requires West Virginia's Public Employees Insurance Agency (PEIA) and other health insurance providers to pay behavioral health, mental health, and substance use disorder providers the same rate as medical/surgical providers for comparable services. This applies to licensed practitioners (e.g., psychologists, counselors) who submit claims with standard diagnostic codes, provider IDs, and facility details. Insurers cannot reduce physician reimbursements to comply with this rule or apply stricter non-quantitative limits to behavioral health care than to medical care. The bill directly affects behavioral health providers by ensuring equal payment for services previously subject to lower reimbursement rates.

Topics ✓ HealthcareSupports HealthcareMandates equal reimbursement rates for mental health services, strengthening provider access and coverage parity per bill's payment parity requirement for behavioral health.95% confidence

Sub-Topics Insurance Mental Health Substance Abuse

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in committee · West Virginia · House of Delegates Jan 26, 2026

HB 4821: Creating the Affordable Medicaid Buy-In Program

HB 4821 creates a new state-run health insurance program in West Virginia that allows eligible residents to "buy in" to a Medicaid-like plan. It directly affects adults who are ineligible for Medicaid or Medicare but remain enrolled in employer-sponsored coverage (and whose employers haven’t denied them coverage due to this program). The plan uses a sliding-scale premium based on income, covers essential services like hospital care, mental health, prescriptions, and preventive care, and must coordinate with existing Medicaid to avoid coverage gaps. The West Virginia Department of Human Services will administer the program, prioritizing those transitioning from Medicaid, and must apply for federal funding to maximize cost efficiency.

Topics ✓ HealthcareSupports HealthcareCreates Medicaid-like buy-in program for eligible adults, covers essential services with sliding-scale premiums, expanding access to health coverage.95% confidence

Sub-Topics Hospitals Insurance Medicaid

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in committee · West Virginia · House of Delegates Jan 29, 2026

HB 4117: Prohibiting surprise billing of ground emergency medical services by nonparticipating providers

HB 4117 prohibits surprise billing for ground emergency ambulance services by nonparticipating providers in West Virginia. It requires health insurers to pay ambulance providers directly (at the lesser of 400% of Medicare's rate or the provider's billed charges) within 30 days of receiving a clean claim, and bans providers from billing patients for amounts beyond what the insurer requires (like copays or deductibles). This directly affects patients receiving ambulance services, nonparticipating ambulance agencies, and health insurers. The bill ensures patients won’t face unexpected bills for emergency ground ambulance care, with clear payment rules and written denial notices for denied claims.

Topics ✓ HealthcareSupports HealthcareProhibits surprise billing for emergency ambulance services, requiring insurers to pay providers directly and protecting patients from excessive out-of-pocket costs.95% confidence

Sub-Topics Insurance Medicare

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signed · West Virginia · Senate Jun 25, 2026

SB 645: Prohibiting surprise billing of ground emergency medical services by nonparticipating providers

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.

Topics ✓ HealthcareSupports HealthcarePrevents surprise billing for emergency ambulance services, protecting patients from extra charges and requiring insurers to pay at 400% Medicare rate.95% confidence

Sub-Topics Insurance Medicare

in committee · West Virginia · House of Delegates Jan 26, 2026

HB 4822: To redirect data center tax revenue to PEIA, counties, and schools

HB 4822 redirects tax revenue from "High Impact Data Centers" (as defined under West Virginia law) to three specific recipients: the Public Employees Insurance Association (PEIA) fund, local counties, and public school boards. The bill amends tax distribution rules to require that incremental property tax revenue from these data centers - calculated using a new formula based on assessed value and levy rates - be reallocated instead of following previous distribution methods. This change directly affects data centers certified as "High Impact" under §11-6N-2, ensuring their tax contributions support state health insurance programs, county services, and school funding. The policy shift replaces prior tax allocation rules with a fixed distribution structure for these facilities.

Topics ✓ Budget & TaxesSupports Budget & TaxesRedirects existing data center tax revenue to fund PEIA, counties, and schools, increasing public service funding per bill's explicit tax reallocation mandate.95% confidence ✓ EducationSupports EducationRedirects data center tax revenue to public school boards, increasing education funding per bill's explicit allocation to schools.95% confidence ✓ HealthcareSupports HealthcareRedirects data center tax revenue to PEIA fund, directly increasing healthcare funding for public employees' insurance coverage.95% confidence

Sub-Topics Property Tax Revenue School Funding Insurance

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in committee · West Virginia · House of Delegates Jan 30, 2026

HB 4316: Relating to authorizing the Board of Physical Therapy to promulgate a legislative rule relating to general provisions for athletic trainers.

HB 4316 authorizes West Virginia's Board of Physical Therapy to establish a specific rule (16 CSR 05) governing general practice standards for athletic trainers. This rule will directly affect athletic trainers by setting requirements for their licensure, scope of practice, and professional conduct within the state. The bill formally approves a previously modified rule that was reviewed and refiled after addressing concerns raised by the Legislative Rule-Making Review Committee.

Topics ✓ HealthcareSupports HealthcareAuthorizes standards for athletic trainers' licensure and scope of practice, strengthening regulatory oversight in healthcare services and protecting patient safety through professional conduct rules.90% confidence

Sub-Topics Healthcare Workforce Medical Licensing

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in committee · West Virginia · Senate Jan 15, 2026

SB 295: Insurance Commissioner rule relating to mental health parity

This bill authorizes West Virginia's Insurance Commissioner to implement a specific rule (114 CSR 64) regarding mental health parity. It formally incorporates an existing rule, filed April 16, 2025, into state law under §64-7-1 of the Code. The rule requires health insurance plans to cover mental health services at the same level as physical health care, directly affecting insurance companies and policyholders in West Virginia. The bill itself does not change the coverage requirements but legally authorizes the Commissioner to enforce the existing parity rule.

Topics ✓ HealthcareSupports HealthcareRequires equal mental health insurance coverage parity, strengthening patient access to mental health services under state law per existing rule 114 CSR 64.95% confidence

Sub-Topics Insurance Mental Health

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in committee · West Virginia · Senate Jan 16, 2026

SB 471: Authorizing physician assistants to own business

This bill (SB 471) allows physician assistants (PAs) in West Virginia to own healthcare-related businesses, such as clinics or practices. It specifically prohibits PAs from having a financial interest in referral arrangements (e.g., owning a clinic they refer patients to) and permits medical corporations to have PA shareholders. The bill also designates physician assistants as a "professional service" under the state’s Uniform Limited Liability Company Act, enabling PAs to form or join LLCs for their practice. These changes directly affect PAs seeking to establish or invest in healthcare businesses.

Topics ✓ HealthcareSupports HealthcareEnables PAs to own clinics, expanding healthcare access and designating PAs as professional service under LLC law. Prohibits referral conflicts to protect patients.90% confidence

Sub-Topics Primary Care

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in committee · West Virginia · Senate Jan 20, 2026

SB 526: Relating to PEIA Cost Sharing Provisions

SB 526 modifies how public employee health insurance premiums are calculated under West Virginia's Public Employees Insurance Agency (PEIA). It requires the finance board to develop annual financial plans with actuarial review, ensuring plans cover all costs including claims. The bill establishes specific reimbursement rates (110% of Medicare for providers), sets employer/employee cost-sharing percentages, and allows different cost levels based on ability to pay for current employees and retirees. It also permits subsidizing retired employees' coverage through employer premiums. This directly affects all West Virginia public employees, retirees, state employers, and healthcare providers participating in PEIA.

Topics ✓ HealthcareSupports HealthcareEnsures PEIA covers all costs via actuarial review, sets reimbursement rates, and adjusts cost-sharing to stabilize public employee health insurance program, supporting coverage sustainability.90% confidence

Sub-Topics Insurance Medicare

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in committee · West Virginia · House of Delegates Jan 22, 2026

HB 4300: Relating to authorizing the Board of Optometry to promulgate a legislative rule relating to oral pharmaceutical certificates.

This bill authorizes West Virginia's Board of Optometry to create and implement a specific rule about oral pharmaceutical certificates. It formally approves a rule the Board had previously proposed (documented as 14 CSR 02), which addresses optometrists' authority to prescribe certain medications orally. The rule was modified after feedback from the Legislative Rule-Making Review Committee and refiled in 2025. This change directly affects optometrists and the Board of Optometry by establishing clear regulatory procedures for prescribing practices. The bill does not create new policy but confirms the Board's authority to enforce an existing rule.

Topics ✓ HealthcareSupports HealthcareAuthorizes optometrists to prescribe oral medications, expanding provider scope and improving patient access to care within healthcare services.85% confidence

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