West Virginia HB4965: Relating to patient-centered treatment flexibility within the Public Employees Insurance Agency

What the bill says

An act to amend the Code of West Virginia, 1931, as amended, by adding a new section, designated §5-16-7h, relating to patient-centered treatment flexibility with the Public Employees Insurance Agency. ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT. §5-16-7h. Patient-centered treatment flexibility. (a) For purposes of this section: "Covered treatment" means a service, procedure, therapy, medication, or course of care covered under an agency health plan. "Alternative treatment" means a different covered treatment for the same diagnosed condition or illness that is medically appropriat.

From the enrolled text, March 12, 2026:

AN ACT to amend the Code of West Virginia, 1931, as amended, by adding a new section, designated §5-16-7h, relating to patient-centered treatment flexibility with the Public Employees Insurance Agency. ARTICLE 16. WEST VIRGINIA PUBLIC EMPLOYEES INSURANCE ACT. §5-16-7h. Patient-centered treatment flexibility. (a) For purposes of this section: "Covered treatment" means a service, procedure, therapy, medication, or course of care covered under an agency health plan. "Alternative treatment" means a different covered treatment for the same diagnosed condition or illness that is medically appropriate and clinically indicated, "Prior authorization" means approval issued by the agency or its administrator authorizing coverage of a specific treatment. (b) If a patient has received prior authorization from the agency for a covered treatment for a diagnosed condition, the patient may receive an alternative covered treatment for the same condition without requiring a new or additional prior authorization, subject to the requirements of this section. A patient is not eligible to receive the alternative treatment and the original covered treatment at the same time. (c) The agency shall provide coverage for an alternative treatment selected pursuant to subsection (b) of this section and may not deny coverage solely on the basis that the alternative treatment was not separately prior authorized, and (2) The total allowed cost to the agency for the alternative treatment does not …

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