HB 2861
Mental Health and Substance Use Disorders Insurance Coverage Protection Act
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- Passed House of Delegates
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill, the Mental Health and Substance Use Disorders Insurance Coverage Protection Act, aims to improve mental health and substance use disorder coverage in West Virginia. It requires insurance policies issued on or after January 1, 2026, to cover medically necessary treatment for these disorders, mandates adherence to generally accepted standards in determining medical necessity, and prohibits insurers from using discretionary clauses that could limit coverage. The bill also establishes a framework for ensuring consistent and evidence-based utilization review practices.
Key provisions
- Requires insurance policies issued on or after January 1, 2026, to cover medically necessary treatment for mental health and substance use disorders.
- Mandates that medical necessity determinations follow generally accepted standards of care.
- Prohibits insurers from using discretionary clauses that could limit coverage for these disorders.
- Establishes criteria for utilization review that must align with generally accepted standards.
- Requires insurers to educate their staff on clinical review criteria.
- Specifies a minimum interrater reliability pass rate for utilization review decisions.
- Prohibits insurers from denying coverage based on eligibility for public entitlement programs.
- Creates the Mental Health and Substance Use Disorders Insurance Coverage Protection Act.
Who is affected
- Insurance companies
- Individuals with mental health or substance use disorders
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