HB 5266
Requiring West Virginia Medicaid managed care organizations to contract with any otherwise qualified provider
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Sign in to take action- Introduced
- Passed House of Delegates
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill requires West Virginia’s Medicaid managed care organizations to work with any qualified healthcare provider who is willing to accept Medicaid payments and terms, similar to other providers in their network. Currently, managed care organizations may limit their networks, potentially restricting patient access to care. The bill aims to ensure that all otherwise qualified providers can participate in the West Virginia Medicaid program. It establishes a process for providers to be approved and included in the managed care networks.
Key provisions
- Medicaid managed care organizations must contract with willing providers.
- Providers must meet all Medicaid enrollment and licensing requirements.
- Providers must have a Medicaid provider number.
- Providers must meet the managed care organization’s credentialing standards.
- Providers must not be otherwise disqualified from Medicare or Medicaid.
- Reimbursement rates and terms must be comparable to those offered to similar providers.
Who is affected
- West Virginia Medicaid managed care organizations
- Healthcare providers (hospitals, doctors, behavioral health providers)
- Medicaid recipients in West Virginia
- The West Virginia Department of Health and Human Resources
Notable changes
- Requires managed care organizations to expand their networks to include all willing, qualified providers.
- Addresses potential limitations on provider access within Medicaid managed care plans.
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