Bill > SB231

This bill aims to address West Virginia's substance use disorder crisis by reorganizing the state's addiction care system into a value-based continuum of care, meaning providers will be paid based on the quality and cost-effectiveness of the services they provide and the health outcomes of their patients, rather than simply the volume of services rendered. Key provisions include establishing a "baseline year" to collect data on costs, quality, and outcomes to set performance benchmarks, developing standardized billing codes for all substance use disorder services by October 1, 2026, and creating specific outcome-based performance measures by July 1, 2026, which will focus on factors like housing stability, sobriety, avoidance of further legal or child welfare issues, and self-sufficiency. The Bureau for Medical Services will analyze data to identify trends, improve quality, and determine how to implement these value-based payments, with a requirement to report findings annually to the Legislative Oversight Commission on Health and Human Resources Accountability. The bill also mandates that the Bureau for Medical Services seek approval from the Centers for Medicare and Medicaid Services (CMS) for any necessary payment and coverage changes, and crucially, the entire article will have no effect if CMS does not approve the proposed state plan amendment.

Budget and Finance, Health and Social Services

http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=231&year=2026&sessiontype=RS&btype=bill