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Bill

HB 5379

To require payment by insurers directly to the out-of-network emergency medical services agency and the prompt payment of clean claims.

2026 Regular Session Introduced by Mike Hite and 1 co-sponsor

Direct payment of out-of-network EMS claims from insurers to the EMS agencies and faster, prompt payment of clean claims.

To House Finance
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Bill Summary · HB 5379

Bill Summary: HB 5379 (West Virginia, 2026)

Primary purpose and intent

  • HB 5379 seeks to reform how payments are made for emergency medical services rendered by out-of-network (OON) providers and to promote the prompt payment of clean claims.
  • The core goals are to ensure insurers directly pay OON emergency medical services agencies and to establish timeliness standards for paying clean claims, thereby reducing delays and disputes in claim settlements.

Key provisions and changes (as described by the bill’s title and motion history)

  • Direct payment to OON emergency medical services agency: Insurers would be required to make payment directly to the out-of-network emergency medical services (EMS) agency that provided the service, rather than routing payments to other intermediaries or to insured individuals.
  • Prompt payment of clean claims: Insurers would be obligated to promptly pay clean claims. A “clean claim” typically refers to a bill that has no outstanding issues (e.g., missing information, disputed charges) and is ready for payment under the insurer’s policies.
  • Scope: Applies to emergency medical services that are rendered on an out-of-network basis. This addresses situations where patients receive emergency care from providers not in the patient’s insurer network.
  • Administrative and regulatory alignment: The bill is designed to adjust payment flow and timeliness requirements within the state’s regulatory framework for health insurers and EMS providers.

Who is affected

  • Insurers: Health insurers operating within West Virginia would need to comply with the direct-payment obligation and the prompt-clean-claims timelines.
  • Out-of-network emergency medical services agencies: EMS providers that operate outside the patient’s insurer network would receive payments directly from insurers under the new requirement.
  • Patients/consumers: Indirectly affected through potentially faster and more direct payments to EMS agencies, which could influence billing practices and out-of-pocket cost dynamics during emergencies.
  • State regulators/Department of Health and Human Resources: May presume enhanced oversight to ensure compliance, adjust procedures, and enforce timely payments.

Procedural and timeline aspects

  • Introduction and committee path: The bill was introduced on February 9, 2026, and initially referred to House Health and Human Resources, then to Finance.
  • Markup and potential amendments: A markup discussion occurred on February 10, 2026, indicating consideration of bill language and potential amendments.
  • Committee action: On February 13, 2026, the bill advanced with a “Do pass, but first to Finance” action, indicating the Finance Committee will review funding-related implications and any fiscal impact before final floor consideration.
  • Sponsorship: Co-sponsors include Mike Hite and Mickey Petitto, indicating bipartisan or cross-district backing within the House.

Potential impact and considerations

  • Financial flow: Direct payment to OON EMS agencies could streamline revenue cycles for EMS providers and reduce delays caused by intermediaries.
  • Compliance burden: Insurers will need to implement processes to identify OON emergency services and ensure direct payments to the correct EMS agencies, with appropriate documentation.
  • Rate considerations: The bill may interact with existing balance billing rules and state laws governing reimbursement rates for OON emergency services; further details would be clarified in the bill’s text.
  • Consumer protection: By promoting prompt payment of clean claims, the bill aims to reduce prolonged claim disputes and improve overall claims experience for patients.

If you’d like, I can refine this summary further with the exact statutory language once available or expand on related West Virginia EMS and health-insurance payment practices for context.

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

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