WV HB5077

Creates the Mental Health and Substance Use Disorders Insurance Coverage Protection Act, requiring all insurance policies issued or renewed after January 1, 2027, to cover medically necessary treatment for mental health and substance use disorders.

Mandates that insurers base medical necessity determinations on generally accepted standards of care from recognized clinical specialties, peer-reviewed studies, and professional association guidelines rather than internal criteria.

Prohibits insurers from limiting coverage for chronic or pervasive mental health conditions to short-term treatment, and bars denial of benefits because services could be covered by public programs like Medicaid or special education.

Requires insurers to achieve at least 90% interrater reliability in utilization review decisions and provide staff education on clinical review criteria through nonprofit clinical specialty associations.

Establishes civil penalties of up to $5,000 per violation ($10,000 for willful violations) and voids contract provisions giving insurers discretionary authority to interpret coverage terms in ways inconsistent with state law.