Bill > SB822

This bill revises the process for obtaining prior authorization for medical services, commonly known as the "gold card" process, by expanding its eligibility to include hospitals or departments within hospitals, not just individual physicians. It also extends the duration for which a gold card is valid to 12 months and clarifies that a gold card exemption applies to a provider's National Provider Identifier (NPI). The bill mandates that the Office of the Insurance Commissioner (OIC) must provide requested data to providers within 24 hours if they believe they qualify for gold card status but have not yet received it, and establishes a standardized gold carding process for all payers by January 1, 2027. Additionally, it increases the potential civil penalty for violations of prior authorization rules to up to $10,000 per violation and sets a new effective date for these changes to January 1, 2027. The definition of "prior authorization" is also updated to require advance approval for services or medications costing over $10,000.

Health and Social Services

http://www.wvlegislature.gov/Bill_Status/Bills_history.cfm?input=822&year=2026&sessiontype=RS&btype=bill