June 18, 2024
Effective June 6, 2024, Article 4C of Chapter 16 of the West Virginia Code was amended to provide that an emergency medical services agency (e.g., a ground ambulance) may triage and transport a patient to an alternative treatment destination or treat in place if the agency is coordinating the care of the patient through medical command or telehealth services with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint.
The bill requires the emergency medical services agency to execute a memorandum of understanding with alternative treatment destinations as permitted by the protocols to transport patients. An “alternative destination” is defined as “a lower-acuity facility that provides medical services,” which includes a federally qualified health center, an urgent care center, a rural health clinic, a physician’s office or medical clinic as selected by the patient, and a behavioral or mental health clinic facility.
The legislation further requires commercial health insurance plans issued on or after January 1, 2025, to provide coverage for this new requirement. The bill also requires insurance coverage, subject to deductibles or copayment requirements, for prehospital screening and stabilization of emergency conditions by an ambulance service if the insured is transported to an emergency room of a facility provider or if the patient declines to be transported against medical advice.
Health plan sponsors may see this new coverage in their 2025 renewals.
West Virginia Code Section 16-4C
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