Healthcare

HB 4982 reestablishes West Virginia's statewide Healthy Lifestyles program, creating the Office of Healthy Lifestyles within the Department of Health. It directly affects all West Virginia residents, particularly Medicaid members with nutrition-related chronic diseases (like obesity or diabetes), by expanding access to "Food Is Medicine" services such as nutrition counseling, medically tailored meals, and grocery provisions. Key provisions include requiring the Bureau for Medical Services to design nutrition-based interventions to reduce healthcare costs, establishing a Healthy Lifestyle Coalition with 13 members to coordinate state and community efforts, and mandating physical fitness initiatives in schools. The bill also repeals previous program sections and adds new rules to promote nutritious food access and prevent diet-related diseases.

This bill exempts the West Virginia Department of Health from certain state purchasing restrictions when implementing the federal Rural Health Transformation Program. The legislation allows the state to use federal funds more flexibly to meet the program's strict requirements for rapid deployment and specific use of money in rural healthcare areas. By overriding existing state purchasing laws, the bill ensures the Department of Health can comply with federal guidelines from the Centers for Medicare and Medicaid Services without administrative delays. This change directly affects the state's ability to manage federal grants aimed at improving healthcare infrastructure and services in rural communities.

This bill establishes a value-based payment system for West Virginia's Medicaid addiction care services, shifting from fee-for-service to rewarding providers based on patient recovery outcomes. It directly affects Medicaid providers treating substance use disorders by requiring them to use standardized billing codes starting in 2027 and report on five specific outcome metrics: housing stability, sobriety, avoidance of criminal justice involvement, self-sufficiency (employment/education), and provider transition plans. The bill mandates data collection and analysis by the Bureau for Medical Services to develop these metrics, with value-based payments requiring implementation by 2028. The goal is to create a coordinated care system focused on long-term recovery success rather than fragmented service volume.

West Virginia Senate Bill 645 prohibits non-network ambulance services from charging patients extra fees beyond standard insurance cost-sharing. It requires insurers to pay non-participating ambulance providers directly at 400% of the Medicare rate (or the provider’s billed amount, whichever is lower) within 30 days of a clean claim. Patients cannot be billed for amounts beyond their standard copayments, coinsurance, or deductibles, and insurers must provide written denial notices with specific reasons. This applies to ground ambulance services covered under health insurance policies issued on or after January 1, 2027.