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HB 5022

Relating to expanding the programs to be included in the annual capitation rate review.

2026 Regular Session Introduced by Evan Worrell

HB 5022 expands West Virginia's annual capitation rate review to include additional healthcare programs, potentially affecting reimbursement rates across more state-administered health services.

Chapter 164, Acts, Regular Session, 2026
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Bill Summary · HB 5022

Legislative bill overview

HB 5022 expands the scope of West Virginia's annual capitation rate review process to include additional healthcare programs beyond those currently covered. The bill modifies which programs must undergo systematic review of their per-member payment rates during the annual evaluation cycle. This affects how the state determines reimbursement rates for managed care and other healthcare delivery programs.

Why is this important

Capitation rates directly determine healthcare provider reimbursement and program sustainability. Expanding the review scope could impact budget planning, program viability, and access to care if rates are adjusted based on broader program inclusion. The change may affect multiple healthcare sectors including Medicaid managed care, insurance programs, or other state-administered health services.

Potential points of contention

  • Budget implications: Including additional programs in rate reviews could increase administrative costs and create pressure for rate adjustments across more programs, with uncertain fiscal impact
  • Program-specific concerns: Different programs may have different cost structures and needs; uniform review processes may not account for program-specific variations
  • Implementation timeline: Unclear whether expansions must be implemented immediately or phased in, affecting stakeholder planning and resource allocation

Compiled from official sources — confirm details with the bill’s official record.

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