Overview
West Virginia has made progress in healthcare price transparency on several fronts, including implementing an all-payer claims database, passing legislation easing access to medical records, and creating annual financial disclosure requirements for facilities in order to determine the reasonableness of healthcare costs among providers. The state earns a high grade in providing statutory protections for patients against surprise billing for emergency services, although none exist for non-emergency services. The legislature also introduced a bill that would establish a Right to Shop program to require insurance carriers to develop health care transparency tools, allowing patients to search for the highest value health care.
In the healthcare markets, West Virginia closely regulates hospital prices, requiring hospitals to submit all changes and amendments to hospital charges for approval. However, the state does not have a strong merger review law, as only notice to the certificate of need program is required for healthcare provider transactions. The law further provides that financially distressed hospitals are exempted in acquisition proceedings from going through the traditional CON process. Additionally, competition in the insurance market is weak, as only one carrier (Highmark) issued qualified health plans on the individual insurance market until CareSource joined the exchange in 2016, and premiums for employer-sponsored plans in West Virginia are some of the highest in the country.
West Virginia had joined a growing number of states that aim to reduce the cost of prescription drugs by increasing transparency around pricing. In recent terms, West Virginia introduced a number of legislation aimed at reducing consumer cost-sharing for pharmaceuticals. The state successfully enacted the Pharmacy Audit Integrity and Transparency Act, which provides that a pharmacy may inform consumers of lower cost alternatives and cost share to assist health care consumers, and penalizes any pharmacy benefit managers that attempt to prohibit such disclosure. The legislature also successfully expanded the authority to regulate pharmacy benefit managers by expanding the Pharmacy Audit Integrity Act and Fairness in Cost-Sharing Calculation Act.
In 2024, the state considered a number of bills that would have affected Certificate of Need rules, but ultimately none passed.
See below for an overview of existing West Virginia state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/11/2023 - 3/11/2023 (2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 2004 – West Virginia
Introduced: 2021 Status: Inactive / Dead
The purpose of this bill is to permit a licensed health care professional from another to state to practice in this state through telehealth when registered with the appropriate West Virginia board. A BILL to …
HB 2005 – West Virginia
Introduced: 2021 Status: Enacted
AN ACT to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §33-2-24, relating to health care costs generally; requiring the Insurance Commissioner to enforce the applicable provisions …
HB 2007 – West Virginia
Introduced: 2020 Status: Inactive / Dead
Eliminating the certificate of need program. The purpose of this bill is to eliminate the certificate of need program for opiod treatment programs.
HB 2024 – West Virginia
Introduced: 2021 Status: Enacted
The purpose of this bill is to expand the use of telemedicine by allowing medical personnel to participate in telemedicine visits, to ensure parity between telemedicine and in-person visits, and to restrict the ability of …
HB 2068 – West Virginia
Introduced: 2017 Status: Inactive / Dead
This bill authorizes the board of directors of the West Virginia Health Information Network and the West Virginia Health Care Authority to determine and, with the approval of the Joint Committee on Government and Finance, …
W. Va. Code §§ 31E-11-1101 through 31E-11-1104: West Virginia Nonprofit Corporation Act– Mergers – West Virginia
Introduced: Status: Enacted
Statutes govern mergers under the West Virginia Nonprofit Corporation Act.
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W. Va. Code §§ 33-11-1 through 33-11-10: Unfair Trade Practices – West Virginia
Introduced: Status: Enacted
Prohibits engagement in an unfair method of competition or an unfair or deceptive act or practice in the business of insurance.
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W. Va. Code §§ 33-11A-1 through 33-11A-16: Insurance Sales Consumer Protection Act – West Virginia
Introduced: Status: Enacted
Defines terms used in the Insurance Sales Consumer Protection Act article.
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W. Va. Code §§ 33-15-1 through 33-15-21: Accident and Sickness Insurance – West Virginia
Introduced: Status: Enacted
This chapter section applies to individual accident and sickness policies. Describes requirements for approving policies, inclduing premium rates and policy approval.
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W. Va. Code §§ 33-15B-1 through 33-15B-6: Uniform Health Care Administration Act – West Virginia
Introduced: Status: Enacted
The Legislature hereby finds that there is a need to provide guidelines regarding uniform health care administration in order to best serve consumers, health care providers and insurers and to organize and streamline the claims …
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United States of America v. Charleston Area Medical Center, Inc. and St. Mary’s Medical Center, Inc. – West Virginia
District Court: Southern District of West Virginia Charleston Division Status: Decided
On October 21, 2016, a federal district court approved a settlement between St. Mary’s Medical Center, Charleston Area Medical Center, and DOJ. The settlement prohibits …
In the Matter of Cabell Huntington Hospital, Inc., Pallottine Health Services, Inc., and St. Mary’s Medical Center, Inc. – West Virginia
District Court: United States of America Before The Federal Trade Commission Status: Decided
On July 6, 2016 the FTC voted to abandon its challenge to the merger of Cabell Huntington and St. Mary’s hospitals in light of state legislation …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
West Virginia’s fiscal year begins on July 1 and ends on June 30 of the following year. State agencies submit budget requests by September 1. Agency hearings are held September through November. The governor submits his or her proposed budget to the West Virginia State Legislature on or before the second Wednesday in January. A newly elected governor has until the second Wednesday in February. The legislature adopts a budget in March. A simple majority is required to pass a budget.
STATE LEGISLATURE
The state Legislature commences on the second Wednesday of January of each year (although this changes in years following the election of a new governor) and the session may not go beyond 60 calendar days unless extended by a concurrent resolution. West Virginia’s 34 Senators are elected to four year staggered terms, and Members of the House of Delegates for two year terms. Bills carry over from odd numbered to even numbered years.