State Plan Amendment (SPA) 26-0004, Regarding Value-Based Payments for Substance Use Disorder Providers Public Notice

WEST VIRGINIA MEDICAID PROGRAM

STATE PLAN AMENDMENT 26-0004 REGARDING VALUE-BASED PAYMENTS FOR SUBSTANCE USE DISORDER PROVIDERS

Pursuant to 42 C.F.R. §447.205, the Department of Human Services (“Department”), Bureau for Medical Services (“BMS”) provides notice of the filing of a state plan amendment (SPA), identified as SPA 26-0004, regarding Value-Based Payments for Substance Use Disorder (SUD) Providers. 

To align with Senate Bill (SB) 231 from 2026 Regular Session, WV BMS is submitting a SPA by October 1, 2026, to implement value-based payments for Substance Use Disorder (SUD) Providers. “On or before October 1, 2026, the Bureau for Medical Services, to the extent necessary, shall submit a state plan amendment for the appropriate Center for Medicare and Medicaid Services (CMS) authority to implement any payment and coverage changes necessary to effectuate this article.” 

The value-based payments will be effective July 1, 2027. 

SPA 26-0004 attests that BMS will implement a set of outcome-based performance measures which will evaluate both individual recovery outcomes and provider performance.  BMS will require its contracted Managed Care Organizations (MCOs) to implement value-based payment strategies for SUD provider reimbursement that promote quality, outcomes, and efficiency rather than the volume of services delivered.

Changes to the State Plan are drafted in Attachment 4.19-B page 11.2.

This SPA will have an effective date of July 1, 2027, pending CMS approval. The value-based payment methodology is projected to be cost neutral; therefore, this SPA is not expected to have a fiscal impact for Federal Fiscal Year (FFY) 2027 or FFY 2028.

This SPA will be available for public comment on the WV BMS website under the public notices tab at this link between September 25, 2026 and October 25, 2026.

Written comments may be sent between the above referenced dates to the West Virginia Department of Human Services, Bureau for Medical Services, 350 Capitol Street, Suite 251, Charleston, WV 25301-3706, or by email at SPAComments@wv.gov .   

Any written comments received will be available for review at the above address during normal business hours, 8:30 a.m. to 4:30 p.m.