Senate 1055

WEST virginia legislature

2026 regular session

Introduced

Senate Bill 1055

By Senator Helton

[Introduced February 21, 2026; referred
to the Committee on Health and Human Resources; and then to the Committee on Finance]

A BILL to amend the Code of West Virginia, 1931, as amended, by adding a new article, designated §9-5A-1, §9-5A-2, §9-5A-3, and §9-5A-4, relating to conducting a rate study for substance use disorder; setting forth legislative findings and purpose; defining terms; setting forth rate methodology; requiring reporting; requiring stakeholder engagement; and setting forth deadline.

Be it enacted by the Legislature of West Virginia:

ARTICLE 5A. SUBSTANCE USE DISORDER RATE REVIEW AND TRANSPARENCY.

§9-5A-1. Legislative findings and purpose.

(a) The Legislature finds that:

(1) Substance use disorder is a chronic, treatable, medical condition requiring a continuum of evidence-based care;

(2) Regular review of reimbursement methodologies promotes transparency and program integrity;

(3) Data-driven decision-making supports the efficient use of state and federal funds.

(b) The purpose of this article is to:

(1) Establish a structured and transparent process for reviewing Medicaid reimbursement rates for substance use disorder services;

(2) Ensure periodic evaluation of rates using reliable cost and utilization data; and

(3) Support access to services while maintaining fiscal responsibility.

§9-5A-2. Definitions.

For purposes of this article:

(1) "Bureau" means the Bureau for Medical Services;

(2) "Substance use disorder services" includes Medicaid-covered services related to the treatment of substance use disorder, including but not limited to:

(A) Residential treatment (ASAM Levels 3.1, 3.5, 3.7);

(B) Withdrawal management;

(C) Outpatient and intensive outpatient services;

(D) Medication-assisted treatment;

(E) Peer recovery support services; and

(F) Case management and care coordination.

(3) "Rate study" means an actuarial or cost analysis evaluating the costs, utilization, and delivery of services.

§9-5A-3. Rate review methodology.

(a) The Bureau shall utilize a data-informed methodology when reviewing reimbursement rates for substance use disorder services.

(b) The review may include consideration of:

(1) Provider cost data or surveys;

(2) Workforce costs, including wages and benefits;

(3) Service utilization and access trends;

(4) Geographic and rural service delivery considerations;

(5) Administrative and regulatory requirements;

(6) Patient acuity and service intensity;

(7) Inflationary pressures; and

(8) Regional or national benchmarks.

(c) Nothing in this section shall be construed to require the Bureau to adopt any specific reimbursement methodology or rate structure.

§9-5A-4. Reporting and stakeholder engagement.

(a) The Bureau shall engage stakeholders in the rate review process, including providers, managed care organizations, and consumer representatives.

(b) The Bureau shall publish, to the extent practicable:

(1) A summary of rate study findings;

(2) The general methodology used in reviewing rates; and

(3) Any factors considered in rate adjustments.

(c) The Bureau shall provide an annual report to the Legislative Oversight Commission on Health and Human Resources Accountability prior to the 2027 Regular Session of the Legislature, including:

(1) Current reimbursement rates;

(2) Trends in service utilization;

(3) Access to care indicators; and

(4) Summary of stakeholder input.

NOTE: The purpose of this bill is to require the Bureau of Medical Services to use a data informed methodology when reviewing reimbursement rates for substance use disorder services.

Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.