WV HB2861

Requires all health insurance policies issued or renewed on or after January 1, 2026, to provide coverage for medically necessary treatment of mental health and substance use disorders, including public employee insurance plans, accident and sickness insurance, HMOs, and healthcare corporations

Mandates that insurers base medical necessity determinations on current generally accepted standards of mental health and substance use disorder care, using criteria from relevant nonprofit professional clinical specialty associations

Prohibits insurers from limiting coverage for chronic or pervasive mental health and substance use disorders to only short-term or acute treatment, and bars denial of coverage based on availability of public programs like Medicaid or special education

Requires insurers to achieve at least 90% interrater reliability pass rates for utilization review decisions, provide education programs on clinical review criteria, and ensure all denials are reviewed by professionals with equivalent credentials to the requesting provider

Authorizes civil penalties of up to $5,000 per violation (or $10,000 for willful violations) and prohibits discretionary clauses in insurance contracts that would allow insurers sole authority to determine benefit eligibility or interpret contract terms