Healthcare

This bill requires physicians and osteopathic doctors in West Virginia to complete continuing education credits specifically in nutrition as part of their biennial license renewal process. The law mandates that medical professionals earn a minimum of fifty hours of continuing medical education every two years, with osteopathic physicians required to complete thirty-two hours including nutrition training, and these credits must be approved by relevant medical boards. The bill amends existing state code sections to make nutrition education a mandatory component of the continuing education requirement for license renewal.

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.

HB 5096 removes the requirement for state approval (a "certificate of need") for two specific healthcare services in West Virginia: personal care services and intellectual developmental disabilities (IDD) services. This means healthcare providers offering these services no longer need prior state permission before expanding or establishing them. The bill amends existing law (§16-2D-10) to explicitly exempt these services from the certificate of need process, which previously applied to many healthcare expansions and facility changes. This change directly affects providers of personal care (like assistance with daily living activities) and IDD services (such as support for individuals with developmental disabilities), streamlining their ability to operate without state review.