HB 4335: Relating to Medicaid providers - West Virginia

hb4335 sfat helton _ 2-19 adopted.htm → Enrolled Committee Substitute · 6 edits · Mar 2, 2026

MODERATE

This bill replaces the old Medicaid provider credentialing system with a new, streamlined process to speed up provider enrollment and standardize how doctors and hospitals are vetted. It mandates that the state complete enrollment decisions within five business days and requires managed care organizations to finish credentialing within 60 days, with strict penalties for delays. The law also forces the use of a single, simple electronic application form and requires all submissions to be digital, aiming to reduce paperwork and confusion.

Scope change

The bill repeals the previous uniform credentialing articles (Chapter 16, Article 1A) and replaces them with a new section in Chapter 9, shifting the regulatory framework from a standalone credentialing system to one integrated with general human services provisions.

TIMELINE

Mandates a strict five-business-day deadline for the state to decide on Medicaid provider applications.

Sets a 60-calendar-day limit for managed care organizations to credential providers, with a one-time 30-day extension option.

REQUIREMENT

Requires all enrollment and credentialing documents to be submitted exclusively via electronic means.

Mandates the use of a single, standardized electronic application form for all managed care organizations.

ENFORCEMENT

Establishes penalties for managed care organizations that miss credentialing deadlines, including monetary sanctions and corrective action plans.

DEFINITION

Repeals the previous definitions and advisory committee structures found in the old Chapter 16, Article 1A.

Engrossed Committee Substitute → hb4335 sfat helton _ 2-19 adopted.htm · 4 edits

MODERATE

The bill text was updated to reflect a Senate amendment that clarifies the bill's purpose and corrects terminology, changing 'fiscal agent' to 'state's agent' and removing redundant credentialing requirements. The amendment also adds a note indicating the bill was adopted on February 19, replacing the previous committee substitute header. No substantive policy changes regarding dates, penalties, or operational procedures were made in this specific text update.

Scope change

The scope remains focused on Medicaid provider enrollment and credentialing, but the legislative text now explicitly removes duplicative uniform credentialing requirements as noted in the amended title.

REQUIREMENT

The bill title was amended to strike out 'fiscal agent' and replace it with 'state's agent' for accuracy.

The amended title explicitly states that the bill removes duplicative uniform credentialing requirements, clarifying the intent to streamline existing processes.

TECHNICAL

A new header was added indicating the bill was 'Adopted' on 2-19, replacing the previous 'Engrossed Committee Substitute' designation.

The original navigation menu and footer links from the webpage were removed as they are not part of the legislative text.

Committee Substitute → Engrossed Committee Substitute · 1 edit · Feb 20, 2026

MINOR

The bill version was updated from a Committee Substitute to an Engrossed Version, reflecting final legislative approval. The substantive policy content regarding Medicaid provider credentialing, electronic submission requirements, and the repeal of specific sections remains unchanged from the previous version.

TECHNICAL

The document title and version labels were updated to reflect the bill's progression to the Engrossed Version, indicating it has passed committee review and is ready for final passage.

Introduced Version → Committee Substitute · 3 edits

MINOR

The bill was revised from an Introduced Version to a Committee Substitute, updating the header to reflect its committee origin and status. The most significant substantive change is the addition of a requirement that the state's fiscal agent be accredited by the National Committee for Quality Assurance (NCQA) by July 1, 2026. Other changes include minor formatting adjustments and clarifications to the text regarding managed care organizations and electronic submissions.

Scope change

The bill's scope remains focused on Medicaid provider enrollment and credentialing, but the applicability of the new accreditation requirement is now explicitly tied to the state's fiscal agent.

REQUIREMENT

Added a new requirement that the state's fiscal agent must be accredited by the National Committee for Quality Assurance (NCQA) by July 1, 2026.

TECHNICAL

Updated the bill header and introductory text to reflect that this is the Committee Substitute version, replacing the Introduced Version label and adding committee reporting details.

Adjusted phrasing in subsection (c) to clarify that the Office of the Insurance Commissioner must prescribe the form by July 1, 2026, and refined references to 'contracting entities' to specifically mention 'Medicaid managed care organizations'.

Relating to Medicaid providers

What changed between versions

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