HB 4061
Requiring PEIA and other health insurance providers to provide payment parity for certain services
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- Passed House of Delegates
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill aims to ensure that health insurance providers in West Virginia, including PEIA, provide the same level of payment for mental health, behavioral health, and medical/surgical services. It sets requirements for how these providers handle claims, prohibits reducing reimbursement for mental health providers, and aligns with federal guidelines to promote parity in care. The bill also includes provisions related to autism spectrum disorder coverage and specific treatments.
Key provisions
- Requires PEIA and other health insurance providers to provide payment parity for behavioral health, mental health, and medical/surgical services.
- Sets requirements for claim submission, including the use of specific diagnosis and procedure codes.
- Prohibits insurers from reducing reimbursement paid to physicians for mental health services.
- Establishes criteria for determining medical necessity for mental health treatments.
- Includes coverage for autism spectrum disorder treatment up to age 18.
- Mandates coverage for amino acid-based formula for severe protein-allergic conditions.
- Requires annual reporting on parity compliance by the Public Employees Insurance Agency.
- Addresses coverage for 12-month refill for contraceptive drugs.
Who is affected
- Public Employees Insurance Agency (PEIA)
- Health insurance providers in West Virginia
- Employees of West Virginia state government
- Healthcare providers (physicians, therapists, etc.)
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