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West VirginiaSB 2312026 Regular SessionSenateWALLET

Relating to value-based payment requirements

Sponsored By: Brian Helton (Republican)

Signed by Governor

§9-11-1§9-11-2§9-11-3§9-11-4§9-11-5§9-11-6

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 3 benefits, 0 costs, 2 mixed.

Federal approval required for these changes

By October 1, 2026, the Bureau submits a state plan amendment to federal CMS as needed. These changes only take effect if CMS approves. Without approval, the article has no force.

Addiction care payments tied to results

A one-year baseline starts on or before July 1, 2027 to set benchmarks. By July 1, 2028, Medicaid managed care plans must pay for addiction services using value-based payments tied to approved outcome measures and standard codes. This changes how providers are paid, aiming for better results.

Outcome measures for Medicaid addiction care

By July 1, 2026, the state sets outcome measures for every level of addiction care. The Bureau works with health experts, providers, law enforcement, and people in recovery. Measures include housing stability, sobriety, avoiding justice and child-welfare involvement, self-sufficiency, and transition planning. They must be verifiable, allow tiers by patient needs, include social factors, and protect privacy under HIPAA.

Bonuses, penalties, and provider removal

The payment model pays more to providers who meet outcomes and less to those who do not. If a provider misses targets for three straight quarters, the state can decertify them, block certain billing codes, or end Medicaid participation. The model uses the baseline year, is reviewed yearly, and tracks return on health investment.

Standard billing codes and data checks

The state sets standard billing codes for substance use care by October 1, 2026. Providers must use them by January 15, 2027. The Bureau collects billing and outcome data to track use, costs, and results. Suspected overuse or overbilling goes to the Medicaid Fraud Control Unit.

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Sponsors & Cosponsors

Sponsor

  • Brian Helton

    Republican • Senate

Cosponsors

  • T. Kevan Bartlett

    Republican • Senate

  • Vince Deeds

    Republican • Senate

  • Chris Rose

    Republican • Senate

  • Patricia Rucker

    Republican • Senate

  • Jay Taylor

    Republican • Senate

  • Jimmy Willis

    Republican • House

Roll Call Votes

All Roll Calls

Yes: 246 • No: 7

Senate vote • 3/14/2026

Senate concurred in House amendments and passed bill (Roll No. 655)

Yes: 34 • No: 0

House vote • 3/13/2026

Effective July, 1, 2026 (Roll No. 521)

Yes: 93 • No: 0

House vote • 3/13/2026

Passed House (Roll No. 520)

Yes: 86 • No: 7

Senate vote • 2/16/2026

Passed Senate (Roll No. 92)

Yes: 33 • No: 0

Actions Timeline

  1. Approved by Governor 4/1/2026

    4/1/2026Senate

  2. To Governor 3/18/2026

    3/18/2026Senate

  3. House Message received

    3/14/2026Senate

  4. Senate concurred in House amendments and passed bill (Roll No. 655)

    3/14/2026Senate

  5. Communicated to House

    3/14/2026Senate

  6. Completed legislative action

    3/14/2026Senate

  7. Effective ninety days from passage

    3/14/2026Senate

  8. To Governor 3/18/2026 - Senate Journal

    3/14/2026Senate

  9. Approved by Governor 4/1/2026 - Senate Journal

    3/14/2026Senate

  10. Approved by Governor 4/1/2026 - House Journal

    3/14/2026House

  11. On 3rd reading, Special Calendar

    3/13/2026House

  12. Read 3rd time

    3/13/2026House

  13. Passed House (Roll No. 520)

    3/13/2026House

  14. Effective July, 1, 2026 (Roll No. 521)

    3/13/2026House

  15. Communicated to Senate

    3/13/2026House

  16. On 2nd reading, Special Calendar

    3/12/2026House

  17. Read 2nd time

    3/12/2026House

  18. Amendment reported by the Clerk

    3/12/2026House

  19. Committee amendment adopted (Voice vote)

    3/12/2026House

  20. With amendment, do pass

    3/11/2026House

  21. Immediate consideration

    3/11/2026House

  22. Read 1st time

    3/11/2026House

  23. Do pass, but first to Finance

    2/25/2026House

  24. To House Finance

    2/25/2026House

  25. Markup Discussion

    2/19/2026House

Bill Text

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