HB 5077
Related to Mental Health Protection Act
Take action
Record your position on this measure.
Sign in to record your position, submit testimony, or contact your legislator.
Sign in to take action- Introduced
- 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 ensure that insurance policies in West Virginia provide adequate coverage for medically necessary treatment of mental health and substance use disorders. It mandates that insurance policies follow generally accepted standards when determining medical necessity, prohibits insurers from using discretionary clauses to deny coverage, and establishes definitions for key terms related to mental health and substance use care. The bill seeks to improve access to these essential services for West Virginians.
Key provisions
- Requires insurance policies issued on or after January 1, 2027, to provide coverage for medically necessary treatment of mental health and substance use disorders.
- Establishes generally accepted standards for medical necessity determinations in mental health and substance use disorder care.
- Prohibits insurers from using discretionary clauses to deny coverage for these services.
- Defines key terms such as ‘medically necessary treatment,’ ‘generally accepted standards,’ and ‘utilization review.’
- Requires insurers to base medical necessity determinations on current clinical guidelines and criteria.
- Mandates education programs for insurers’ staff on clinical review criteria.
- Establishes penalties for insurers that violate the provisions of the act.
- Prohibits insurers from limiting benefits based on whether services should be covered by public entitlement programs.
Who is affected
Arguments in favor
Reasons to support this legislation.
No arguments in favor have been submitted.
Submit yoursArguments opposed
Reasons to oppose this legislation.
No arguments opposed have been submitted.
Submit yours