SB 565
Requiring PEIA and other health insurance providers to provide payment parity for certain services
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- Passed Senate
- Passed House of Delegates
- 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 services are reimbursed, prohibits insurers from reducing payments to physicians, and establishes procedures for submitting claims. The bill also addresses coverage for autism spectrum disorder and certain medical foods for infants with allergies.
Key provisions
- Requires payment parity for behavioral health, mental health, and substance use disorder services.
- Sets standards for how claims are submitted, including required information for providers.
- Prohibits insurers from reducing reimbursement to physicians.
- Establishes requirements for coverage of autism spectrum disorder treatment.
- Mandates coverage for specific medical foods for infants with severe protein allergies.
- Includes coverage for 12-month refill for contraceptive drugs.
- Requires annual reporting on parity compliance by the Insurance Commissioner.
- Addresses coverage for children’s immunization services.
Who is affected
- Public Employees Insurance Agency (PEIA)
- Health insurance providers in West Virginia
- Physicians
- Employees of the State of West Virginia
- Individuals receiving health insurance coverage
Notable changes
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