Healthcare (Insurance)

vetoed · West Virginia · House of Delegates Apr 2, 2026

HB 4626: Relating to the establishment of a grant program to fund the United States Food and Drug Administration’s drug development trials with ibogaine

HB 4626 establishes a West Virginia grant program to fund U.S. Food and Drug Administration (FDA) drug development trials using ibogaine, a substance being studied for treating opioid use disorder and other neurological/mental health conditions. The program requires applicants (e.g., pharmaceutical companies or research organizations) to demonstrate capacity to conduct FDA trials, secure approval for ibogaine as a medication, and commit to establishing a state presence, securing insurance coverage, and ensuring treatment access for uninsured patients. Applicants must submit detailed trial designs, safety protocols, and plans for intellectual property rights and post-approval implementation, with grants administered through a state selection committee. The bill does not approve ibogaine but aims to accelerate its development pathway through state-funded trials.

Topics ✓ HealthcareSupports HealthcareFunds FDA trials for ibogaine treatment of opioid/mind health conditions, advancing healthcare research and access through grant program.95% confidence

Sub-Topics Insurance Mental Health Substance Abuse

Track

in committee · West Virginia · Senate Jan 20, 2026

SB 548: Requiring transparency of dental health care insurance products

This bill requires West Virginia dental insurance companies to publicly report how much of each premium dollar is spent on actual dental care versus administrative costs, using a standardized format similar to federal requirements. It mandates annual transparency reports showing medical loss ratios (the minimum percentage of premiums spent on care), allows consumers to compare insurers online, and requires rebates to policyholders if less than 80% of premiums fund patient care. The law also prohibits insurers from forcing dentists to accept only credit card payments with fees and ensures clear payment method options. It directly affects dental insurers, dentists, and dental insurance customers in West Virginia.

Topics ✓ HealthcareSupports HealthcareRequires dental insurers to disclose premium spending on care vs admin, mandates rebates for low medical loss ratios, enhancing consumer transparency and accountability in healthcare insurance.95% confidence

Sub-Topics Insurance

Track

in committee · West Virginia · Senate Jan 21, 2026

SB 565: Requiring PEIA and other health insurance providers to provide payment parity for certain services

SB 565 requires West Virginia's Public Employees Insurance Agency (PEIA) and other health insurance providers to pay behavioral health, mental health, and substance use disorder providers the same rate as medical/surgical providers for comparable services. This applies to licensed practitioners (e.g., psychologists, counselors) who submit claims with standard diagnostic codes, provider IDs, and facility details. Insurers cannot reduce physician reimbursements to comply with this rule or apply stricter non-quantitative limits to behavioral health care than to medical care. The bill directly affects behavioral health providers by ensuring equal payment for services previously subject to lower reimbursement rates.

Topics ✓ HealthcareSupports HealthcareMandates equal reimbursement rates for mental health services, strengthening provider access and coverage parity per bill's payment parity requirement for behavioral health.95% confidence

Sub-Topics Insurance Mental Health Substance Abuse

Track

in committee · West Virginia · House of Delegates Jan 26, 2026

HB 4821: Creating the Affordable Medicaid Buy-In Program

HB 4821 creates a new state-run health insurance program in West Virginia that allows eligible residents to "buy in" to a Medicaid-like plan. It directly affects adults who are ineligible for Medicaid or Medicare but remain enrolled in employer-sponsored coverage (and whose employers haven’t denied them coverage due to this program). The plan uses a sliding-scale premium based on income, covers essential services like hospital care, mental health, prescriptions, and preventive care, and must coordinate with existing Medicaid to avoid coverage gaps. The West Virginia Department of Human Services will administer the program, prioritizing those transitioning from Medicaid, and must apply for federal funding to maximize cost efficiency.

Topics ✓ HealthcareSupports HealthcareCreates Medicaid-like buy-in program for eligible adults, covers essential services with sliding-scale premiums, expanding access to health coverage.95% confidence

Sub-Topics Hospitals Insurance Medicaid

Track

in committee · West Virginia · House of Delegates Jan 29, 2026

HB 4117: Prohibiting surprise billing of ground emergency medical services by nonparticipating providers

HB 4117 prohibits surprise billing for ground emergency ambulance services by nonparticipating providers in West Virginia. It requires health insurers to pay ambulance providers directly (at the lesser of 400% of Medicare's rate or the provider's billed charges) within 30 days of receiving a clean claim, and bans providers from billing patients for amounts beyond what the insurer requires (like copays or deductibles). This directly affects patients receiving ambulance services, nonparticipating ambulance agencies, and health insurers. The bill ensures patients won’t face unexpected bills for emergency ground ambulance care, with clear payment rules and written denial notices for denied claims.

Topics ✓ HealthcareSupports HealthcareProhibits surprise billing for emergency ambulance services, requiring insurers to pay providers directly and protecting patients from excessive out-of-pocket costs.95% confidence

Sub-Topics Insurance Medicare

Track

signed · West Virginia · Senate Jun 25, 2026

SB 645: Prohibiting surprise billing of ground emergency medical services by nonparticipating providers

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.

Topics ✓ HealthcareSupports HealthcarePrevents surprise billing for emergency ambulance services, protecting patients from extra charges and requiring insurers to pay at 400% Medicare rate.95% confidence

Sub-Topics Insurance Medicare

in committee · West Virginia · House of Delegates Jan 26, 2026

HB 4822: To redirect data center tax revenue to PEIA, counties, and schools

HB 4822 redirects tax revenue from "High Impact Data Centers" (as defined under West Virginia law) to three specific recipients: the Public Employees Insurance Association (PEIA) fund, local counties, and public school boards. The bill amends tax distribution rules to require that incremental property tax revenue from these data centers - calculated using a new formula based on assessed value and levy rates - be reallocated instead of following previous distribution methods. This change directly affects data centers certified as "High Impact" under §11-6N-2, ensuring their tax contributions support state health insurance programs, county services, and school funding. The policy shift replaces prior tax allocation rules with a fixed distribution structure for these facilities.

Topics ✓ Budget & TaxesSupports Budget & TaxesRedirects existing data center tax revenue to fund PEIA, counties, and schools, increasing public service funding per bill's explicit tax reallocation mandate.95% confidence ✓ EducationSupports EducationRedirects data center tax revenue to public school boards, increasing education funding per bill's explicit allocation to schools.95% confidence ✓ HealthcareSupports HealthcareRedirects data center tax revenue to PEIA fund, directly increasing healthcare funding for public employees' insurance coverage.95% confidence

Sub-Topics Property Tax Revenue School Funding Insurance

Track

in committee · West Virginia · Senate Jan 15, 2026

SB 295: Insurance Commissioner rule relating to mental health parity

This bill authorizes West Virginia's Insurance Commissioner to implement a specific rule (114 CSR 64) regarding mental health parity. It formally incorporates an existing rule, filed April 16, 2025, into state law under §64-7-1 of the Code. The rule requires health insurance plans to cover mental health services at the same level as physical health care, directly affecting insurance companies and policyholders in West Virginia. The bill itself does not change the coverage requirements but legally authorizes the Commissioner to enforce the existing parity rule.

Topics ✓ HealthcareSupports HealthcareRequires equal mental health insurance coverage parity, strengthening patient access to mental health services under state law per existing rule 114 CSR 64.95% confidence

Sub-Topics Insurance Mental Health

Track

in committee · West Virginia · Senate Jan 20, 2026

SB 526: Relating to PEIA Cost Sharing Provisions

SB 526 modifies how public employee health insurance premiums are calculated under West Virginia's Public Employees Insurance Agency (PEIA). It requires the finance board to develop annual financial plans with actuarial review, ensuring plans cover all costs including claims. The bill establishes specific reimbursement rates (110% of Medicare for providers), sets employer/employee cost-sharing percentages, and allows different cost levels based on ability to pay for current employees and retirees. It also permits subsidizing retired employees' coverage through employer premiums. This directly affects all West Virginia public employees, retirees, state employers, and healthcare providers participating in PEIA.

Topics ✓ HealthcareSupports HealthcareEnsures PEIA covers all costs via actuarial review, sets reimbursement rates, and adjusts cost-sharing to stabilize public employee health insurance program, supporting coverage sustainability.90% confidence

Sub-Topics Insurance Medicare

Track

signed · West Virginia · House of Delegates Jun 29, 2026

HB 4009: Relating to the creation of the Portable Benefit Account Act

HB 4009, the Portable Benefit Account Act, creates a new legal framework allowing independent contractors to access portable benefits through individually managed accounts. It directly affects independent contractors and hiring parties (businesses that contract with them), enabling voluntary contributions from hiring parties to fund benefits like health insurance, retirement plans, life insurance, and income replacement. Key provisions require written, opt-in agreements for contributions, prohibit using account contributions to determine worker classification, and mandate that accounts remain tied to the contractor - not the employer - when changing jobs. The bill establishes definitions for terms like "portable benefit account" and "provider," and requires administrative oversight by the Bank Commissioner.

Topics ✓ HealthcareSupports HealthcareBill explicitly includes health insurance as a covered benefit in portable accounts, enabling independent contractors to access coverage through voluntary employer contributions.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentCreates portable benefits access for independent contractors, expanding health/retirement options typically unavailable to this workforce segment.92% confidence

Sub-Topics Insurance Gig Economy