Healthcare (Medicare)

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

HB 4740: Statutory Commitments in Rural Health Transformation Program

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.

Topics ✓ HealthcareSupports HealthcareBill enables flexible use of federal funds for rural healthcare, improving access and program compliance in underserved areas.90% confidence

Sub-Topics Medicaid Medicare

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

HB 5459: Relating to a tax on managed care organizations

HB 5459 imposes an annual tax on certified health maintenance organizations (HMOs) operating in West Virginia that provide Medicaid services. It establishes tiered tax rates based on Medicaid member months (with higher rates for larger volumes) and non-Medicaid member months, adjusting annually using West Virginia's Medicaid capitation rate changes. Starting July 1, 2027, the tax shifts to a flat 2.5% of each HMO's gross premiums in the state, applying uniformly regardless of membership type. The bill exempts Medicare Advantage plans and certain government health plans as specified in federal law.

Topics ✓ Budget & TaxesSupports Budget & TaxesImposes tax on HMOs to generate state revenue for Medicaid programs, directly increasing government funding under Budget & Taxes.95% confidence ✓ HealthcareSupports HealthcareTax on Medicaid-providing HMOs generates revenue tied to Medicaid capitation rates, potentially funding public health programs per bill's structure.90% confidence

Sub-Topics Medicaid Medicare

in committee · West Virginia · Senate Feb 19, 2026

SB 994: Relating to Medicaid reimbursement rates for certain mental health procedures

SB 994 requires West Virginia Medicaid to set reimbursement rates for outpatient mental health services at the same level as Medicare Part B rates. It directly affects mental health providers in licensed behavioral health centers who offer services like psychotherapy, medication management, and psychiatric evaluations for adults, children, and families. The bill mandates a state board to develop a proposal for these rate increases by July 1, 2026, ensuring Medicaid rates never fall below Medicare rates for identical services. This change aims to improve payment equity for mental health care providers participating in Medicaid.

Topics ✓ HealthcareSupports HealthcareMandates Medicaid reimbursement rates for mental health services to match Medicare Part B rates, increasing provider payments and improving access to care.95% confidence

Sub-Topics Medicaid Medicare Mental Health

Track

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

HB 4869: Establish narrow, clearly bounded guaranteed-issue rights for Medicare Supplement policies in West Virginia.

HB 4869 creates two guaranteed periods for West Virginia seniors to purchase Medicare Supplement (Medigap) policies without medical underwriting or pre-existing condition exclusions. It provides a 60-day window annually around each individual’s birthday for current policyholders to switch to a policy with the same or fewer benefits, and a 63-day window starting the day after Medicaid eligibility ends for those turning 65 or losing Medicaid. Insurers must offer coverage during these periods but are not required to provide new policies or alter existing benefit structures. The bill also mandates annual reports on Medigap premium trends for legislative review but does not change Medicare Advantage plans or require insurers to offer specific rates.

Topics ✓ HealthcareSupports HealthcareCreates guaranteed-issue periods for Medicare Supplement coverage, removing medical underwriting barriers and expanding access for seniors without pre-existing condition exclusions.95% confidence

Sub-Topics Insurance Medicaid Medicare Tags Seniors

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 · 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

in committee · West Virginia · Senate Jan 16, 2026

SB 464: Requiring insurance coverage for biomarker testing

SB 464 requires health insurance plans in West Virginia, including the Public Employees Insurance Act, to cover biomarker testing when ordered by a physician for diagnosis, treatment, or monitoring of a disease, provided the test is medically indicated and has clinical utility. Biomarker testing - such as analyzing tissue or blood samples to identify gene mutations or protein markers that guide treatment decisions - must be based on evidence like FDA approvals, national medical guidelines (e.g., from the National Comprehensive Cancer Network), or Medicare coverage determinations. Insurers must provide a clear online process for appealing coverage denials and avoid requiring multiple biopsies that disrupt care. The bill does not cover routine screening before a diagnosis and mandates the Public Employees Insurance Agency to report implementation costs to the legislature after one year.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for medically necessary biomarker testing, expanding patient access to diagnostic services without financial barriers.95% confidence

Sub-Topics Insurance Medicare

Track

in committee · West Virginia · Senate Jan 16, 2026

SB 434: PEIA Stability and Sustainability Act of 2026

SB 434 creates the PEIA Stability and Sustainability Act of 2026 to stabilize West Virginia's Public Employees Insurance Agency (PEIA), which covers over 200,000 state employees, teachers, public workers, and retirees. It establishes a PEIA Stabilization Reserve Fund funded by 2% of the state's General Revenue each year, sets employer contributions at 82% (minimum 80%) and employee contributions at 18%, and protects retirees by capping premiums at $100/month for those with under $40,000 annual pension income or covering full Medicare Advantage premiums. The bill mandates public transparency for rate changes (with 30-day notice and actuarial justification), creates an independent oversight board with employee and retiree representation, and requires annual accountability reports. These provisions aim to prevent premium spikes, ensure long-term solvency, and maintain affordable coverage for beneficiaries.

Topics ✓ Budget & TaxesSupports Budget & TaxesFunds PEIA stabilization via 2% General Revenue allocation, caps retiree premiums under $40k, promoting fiscal responsibility and tax relief for low-income retirees.92% confidence ✓ HealthcareSupports HealthcareStabilizes PEIA coverage for 200k+ state workers/retirees, caps retiree premiums at $100/month, and funds reserve to protect existing healthcare access.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentCovers 200k+ public workers; caps retiree premiums at $100/month; stabilizes health insurance funding to protect benefits95% confidence

Sub-Topics Pensions Revenue Insurance Medicare

Track

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

HB 4089: Preservation of hair during chemotherapy. Also known as the “Jessica Huffman Bill”

HB 4089, known as "Jessica Huffman's Law," requires health insurers in West Virginia to cover scalp cooling systems for patients undergoing cancer chemotherapy starting January 1, 2027. The bill mandates that any insurance policy covering chemotherapy must include coverage for these devices - described as tools to prevent hair loss during treatment - as defined by Medicare and Medicaid. This applies to policies issued or renewed after 2026, with coverage subject to standard deductibles and coinsurance like other medical benefits. The law directly affects cancer patients seeking hair preservation and insurers offering chemotherapy coverage.

Topics ✓ HealthcareSupports HealthcareMandates insurer coverage for scalp cooling during chemo, expanding access to a quality-of-life treatment under health insurance policies.95% confidence

Sub-Topics Medicaid Medicare