West VirginiaFederal approval gates outcome-based payments for addiction care
West Virginia’s Medicaid agency must track addiction care results and, if federal officials approve its plan, require managed care organizations to tie provider payments to those results.
What it does
The Bureau for Medical Services must track addiction care use and costs by provider and report them to lawmakers. Later reports must also include provider outcomes.
The Bureau must set common billing codes for addiction services and develop ways to measure results at each level of care, with input from people in recovery and others.
Managed care organizations must tie provider payments to addiction care results, with higher payments for meeting targets and lower payments for missing them. Federal approval is required.
Argument forShared measures could help providers and the state spot gaps across addiction care and adjust services to better fit people’s needs.
Argument againstProviders could lose payments or Medicaid participation for missing targets, even when a person’s recovery needs make those targets harder to meet.
More detail
The Bureau for Medical Services must collect service data and report use, costs, and later outcomes to lawmakers. Reports cover providers and provider types across the addiction care system. Reports must use synthetic provider identifiers so lawmakers can follow trends without naming providers. Reports must compare state results with the prior fiscal year and national rates. Use and cost reports begin by January 1, 2028, and continue each year. Outcome reporting begins July 1, 2028. The article has no effect without federal approval of the state plan amendment.
The Bureau for Medical Services must set common billing codes and develop outcome measures for addiction care. The codes cover substance use disorder services; measures must address each level of treatment and recovery care. The Bureau must consult state agencies, universities, people in recovery, providers, law enforcement, and other stakeholders. Codes are due by October 1, 2026, for provider use by January 15, 2027. Outcome measures are due by July 1, 2026. The article has no effect without federal approval of the state plan amendment.
The Bureau for Medical Services must require managed care organizations to tie provider payments to addiction care outcomes. The payment model concerns providers in the addiction care system and managed care organizations that pay them. The state plan amendment must provide enhanced payments for meeting or exceeding measures and reduced payments for missing them. A provider may be excluded from Medicaid after missing measures for three consecutive quarters. These provisions have no effect without federal approval of the state plan amendment. The Bureau must require the payment model by July 1, 2028. The three-quarter rule applies to possible provider exclusion after consecutive missed measures.
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Where it stands
- Introduced
- Passed Senate
- Passed House
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Jun 25Chapter 176, Acts, Regular Session, 2026Latest
- Apr 1Approved by Governor Patrick Morrisey 4/1/2026Major
- Mar 18To Governor 3/18/2026To Governor
- Mar 14Approved by Governor Patrick Morrisey 4/1/2026 - House JournalMajor
- Vote recorded Senate concurred in House amendments and passed bill. Result: pass.Upper
- Mar 14Approved by Governor Patrick Morrisey 4/1/2026 - Senate JournalBecame Law
- Mar 14To Governor 3/18/2026 - Senate JournalMinor
- Mar 14Effective ninety days from passage
- Mar 14Completed legislative action
- Mar 14Communicated to House
- Mar 14Senate concurred in House amendments and passed bill (Roll No. 655)
- Mar 14House Message received
- Mar 13Communicated to Senate
- Vote recorded EFFECT Jul 01, 2026. Result: pass.Lower
- Vote recorded PASSAGE. Result: pass.Lower
- Mar 13Effective July, 1, 2026 (Roll No. 521)
- Mar 13Passed House (Roll No. 520)Passed House
- Mar 13Read 3rd timeMinor
- Mar 13On 3rd reading, Special Calendar
- Mar 12Committee amendment adopted (Voice vote)
- Mar 12Amendment reported by the Clerk
- Mar 12Read 2nd timeMinor
- Mar 12On 2nd reading, Special Calendar
- Mar 11Read 1st timeMinor
- Mar 11Immediate consideration
- Mar 11With amendment, do passMinor
- Feb 25To House FinanceMinor
- Feb 25Do pass, but first to FinanceMinor
- Feb 19Markup Discussion
- Feb 17To House Health and Human ResourcesMinor
- Feb 17To Health and Human Resources then FinanceMinor
- Feb 17Introduced in HouseMinor
- Feb 17House received Senate message
- Feb 16Ordered to House
- Vote recorded Passage. Result: pass.Upper
- Feb 16Passed Senate (Roll No. 92)Passed Senate
- Feb 16Read 3rd timeMinor
- Feb 16On 3rd reading
- Feb 13Read 2nd timeMinor
- Feb 13On 2nd reading
- Feb 12Read 1st timeMinor
- Feb 12On 1st reading
- Feb 11Com. sub. for com. sub. reported
- Jan 16To FinanceMinor
- Jan 16Committee substitute reported, but first to FinanceMinor
- Jan 14To Health and Human ResourcesMinor
- Jan 14Introduced in SenateMinor
- Jan 14To Health and Human Resources then FinanceMinor
- Jan 14Filed for introductionIntroduced
HealthcareMental Health