HB 4965
Relating to patient-centered treatment flexibility within the Public Employees Insurance Agency
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Sign in to take action- Introduced
- Passed House of Delegates
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill aims to provide more flexibility for patients within the Public Employees Insurance Agency (PEIA) health plan. It allows individuals who have received prior authorization for a specific treatment to receive an alternative, medically appropriate treatment for the same condition without needing a new prior authorization, as long as the cost is comparable to the original treatment. The bill also outlines requirements for documentation and agency oversight to ensure appropriate use and cost control.
Key provisions
- Defines ‘covered treatment’ and ‘alternative treatment’ within the PEIA context.
- Allows patients to switch to an alternative treatment for the same condition without additional prior authorization.
- Sets cost limits for alternative treatments, ensuring they don’t exceed the original authorized treatment’s cost.
- Requires documentation from a licensed healthcare provider confirming the appropriateness of the alternative treatment.
- Grants the agency authority to verify costs and audit claims.
- Prohibits requiring new prior authorizations solely for choosing an alternative treatment.
- Prevents unreasonable delays in accessing alternative treatments.
- Maintains the agency’s ability to investigate fraud or abuse.
Who is affected
- Employees of West Virginia state and local government
- Public Employees Insurance Agency (PEIA) members
- Healthcare providers within the PEIA network
- Patients covered by the PEIA health plan
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