West VirginiaHB 49652026 Regular SessionHouseWALLET

Relating to patient-centered treatment flexibility within the Public Employees Insurance Agency

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 1 benefits, 1 costs, 0 mixed.

Easier treatment swaps for state employees

If you have prior authorization from the Public Employees Insurance Agency (PEIA) for a treatment, you can switch to a different covered treatment for the same diagnosis without a new authorization. The alternative must be medically appropriate. Its total allowed cost must not be higher than the allowed cost of the original treatment. You cannot receive both treatments at the same time. PEIA must cover the alternative and cannot deny it only because it lacks its own prior authorization. These rules take effect 90 days after passage.

Rules and limits for state employee treatment swaps

A licensed provider must note in your medical record that the alternative is medically appropriate and treats the same diagnosis. PEIA may ask for reasonable proof that the alternative’s allowed cost is not higher, using its pricing methods. This rule does not cover services the plan does not normally cover. You cannot use it to start care for a new or unrelated diagnosis that needs prior authorization. PEIA can still audit and deny claims for fraud, waste, abuse, or material misrepresentation. These rules take effect 90 days after passage.

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Sponsors & Cosponsors

Sponsor

Laura Kimble
Republican • House

Cosponsors

Margitta Mazzocchi
Republican • House
Adam Vance
Republican • House

Roll Call Votes

All Roll Calls

Yes: 126 • No: 0

Senate vote • 3/12/2026

Passed Senate (Roll No. 497)

Yes: 33 • No: 0

House vote • 3/4/2026

Passed House (Roll No. 290)

Yes: 93 • No: 0

Actions Timeline

Approved by Governor 3/31/2026
4/1/2026House
To Governor 3/25/2026
3/25/2026House
To Governor 3/25/2026 - Senate Journal
3/14/2026Senate
Approved by Governor 3/31/2026 - Senate Journal
3/14/2026Senate
Approved by Governor 3/31/2026 - House Journal
3/14/2026House
House received Senate message
3/13/2026House
On 3rd reading
3/12/2026Senate
Read 3rd time
3/12/2026Senate
Passed Senate (Roll No. 497)
3/12/2026Senate
Communicated to House
3/12/2026Senate
Completed legislative action
3/12/2026Senate
On 2nd reading
3/11/2026Senate
Read 2nd time
3/11/2026Senate
Reported do pass
3/10/2026Senate
Immediate consideration
3/10/2026Senate
Read 1st time
3/10/2026Senate
Introduced in Senate
3/5/2026Senate
To Health and Human Resources
3/5/2026Senate
To Health and Human Resources
3/5/2026Senate
On 3rd reading, Special Calendar
3/4/2026House
Read 3rd time
3/4/2026House
Passed House (Roll No. 290)
3/4/2026House
Communicated to Senate
3/4/2026House
On 2nd reading, Special Calendar
3/3/2026House
Read 2nd time
3/3/2026House

Bill Text

Committee Substitute
HTML PDF
Engrossed
HTML PDF
Enrolled
HTML PDF
Introduced Version
HTML PDF

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