SB 231: Relating to value-based payment requirements - West Virginia

Committee Substitute → Committee Substitute for the Committee Substitute · 9 edits

MAJOR

The bill was renumbered from Chapter 16, Article 67 to Chapter 9, Article 11, moved from the Health and Human Resources Committee to the Finance Committee with expanded sponsorship, and had several substantive changes including a new inoperability clause requiring CMS approval of a state plan amendment before the article takes effect. The baseline year implementation was expanded to specify a one-year data collection period with benchmarks provided to providers, and punitive language throughout was softened from 'penalizing' to 'reduces payments.'

SCOPE

The entire article was renumbered from Chapter 16 (Health), Article 67 to Chapter 9, Article 11, changing the statutory location of the law.

The bill moved from the Committee on Health and Human Resources (reported January 16, 2026) to the Committee on Finance (reported February 11, 2026), with sponsorship expanded from one senator to six.

REQUIREMENT

A new inoperability clause was added: the entire article has no force or effect if CMS does not approve the state plan amendment. This makes federal approval a precondition for the law to take effect.

The baseline year implementation section was expanded from a simple deadline to specify that the baseline year begins on or before July 1, 2027, lasts one year, collects and analyzes performance data to establish benchmarks, and that those benchmarks must be provided to providers so they can improve performance during the baseline year.

The CMS authority section now explicitly requires submission of a 'state plan amendment' (previously just 'submit for the appropriate CMS authority'), and the punitive language was changed from 'penalizing providers' to 'reduces payments to providers who fail to meet outcome measures.'

DEFINITION

A new definition of 'baseline year' was added, specifying it is the designated period during which performance data (cost, quality, utilization, and outcome-based measures) is collected to establish benchmarks.

The definition of 'value-based payment' was softened from 'rewards...and penalizes providers for failure to meet specified metrics' to 'incentivizes...and reduces payments to providers who fail to meet specified metrics.'

TECHNICAL

The value-based measures list (housing stability, sobriety, criminal justice avoidance, self-sufficiency, provider transition plan) and metric requirements were reorganized into a new standalone section 9-11-4 'Use of value-based measures' rather than being subsections of the establishment section.

Minor corrections: 'all states of substance use disorder' changed to 'all stages,' 'Bureau of Medical Service' corrected to 'Bureau for Medical Services,' and a trailing comma was removed from a reporting provision.

Committee Substitute for the Committee Substitute → sb231 h fin am _1 adopted.htm · 2 edits

MINOR

The bill text was replaced with a formal amendment record indicating that the Committee on Finance moved to strike a specific clause requiring anonymized synthetic identifiers in provider reports. This change removes the requirement for unique tracking IDs in the annual data reports, likely to address privacy concerns or simplify data collection procedures.

Scope change

The scope of the reporting requirements was narrowed by removing the mandate for synthetic identifiers, though the rest of the bill's text was not included in the provided snippet.

REQUIREMENT

Removed the requirement that all providers be given an anonymized synthetic identifier in the annual report to allow trends to be followed across multiple years.

PROCEDURAL

Added a header identifying the document as 'SB231 H FIN AM #1' and a footer indicating the amendment was 'Adopted' and 'Rejected'.

Enrolled Version → Committee Substitute · 5 edits

MODERATE

The bill was converted from an 'Enrolled Version' into a 'Committee Substitute', indicating it has been revised by the legislature before final passage. Key substantive changes include renumbering the article and sections, correcting a typo in the definition of 'continuum of care' to specify 'all states' instead of 'all stages', and clarifying the payment model language to explicitly state that providers are penalized for failing to meet metrics. The bill also removed the automatic 90-day effective date and added a note explaining the bill's purpose regarding value-based contracting and state plan amendments.

Scope change

The bill's scope remains focused on addiction care recovery outcomes, but the specific article and section numbers were changed from Article 11 (Sections 9-11-1 through 9-11-6) to Article 67 (Sections 16-67-1 through 16-67-5).

TECHNICAL

The bill was renumbered from Article 11 (Sections 9-11-1 to 9-11-6) to Article 67 (Sections 16-67-1 to 16-67-5).

DEFINITION

The definition of 'continuum of care' was corrected to address the needs of individuals at 'all states' of substance use disorder instead of 'all stages'.

REQUIREMENT

The description of the value-based payment model was clarified to explicitly state that providers are 'penalized' for failure to meet metrics, rather than just having payments reduced.

A new note was added explaining that the bill requires value-based contracting for substance use disorder and mandates a state plan amendment.

TIMELINE

The text stating the bill is 'in effect 90 days from passage' was removed, and the effective date was replaced with a committee report date.

Introduced Version → Enrolled Version · 5 edits · Apr 1, 2026

MODERATE

The bill was finalized as an enrolled act, changing its status from a proposed introduction to a law effective 90 days after passage. The legislation was significantly restructured, moving from Article 67 to Article 11 and renumbering sections to align with the official Code of West Virginia. Substantive changes include the addition of a 'Baseline Year' definition, the inclusion of specific academic institutions in the performance measure development process, and a new provision stating the bill is inoperable without Centers for Medicare and Medicaid Services (CMS) approval.

Scope change

The bill's scope was expanded to include specific academic institutions (Marshall University, WVU) in the development of performance measures, and a new condition was added making the entire bill inoperable if CMS does not approve the required state plan amendment.

TECHNICAL

The bill was reorganized from Article 67 to Article 11 and sections were renumbered from 16-67 to 9-11 to match the official code structure.

DEFINITION

A new definition for 'Baseline Year' was added to establish a specific one-year period for collecting data before performance incentives take effect.

REQUIREMENT

The process for developing performance measures was updated to explicitly include consultation with Marshall University, Joan C. Edwards School of Medicine, and WVU School of Medicine Behavioral Health Faculty.

The description of value-based payments was slightly softened from 'penalizes providers' to 'reduces payments' for those failing to meet metrics.

ENFORCEMENT

A new clause was added stating that the bill has no force or effect if CMS does not approve the required state plan amendment.

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