West Virginia State Flexibility to Stabilize the Market Grant Award

Grant Application Summary

West Virginia Grantee: West Virginia Offices of the Insurance Commissioner

Award Date: August 20, 2018

Total Award: $277,316.68

Baseline Award: $274,344.83

Workload Award: $2,971.85

Section 2707 - The West Virginia Office of the Insurance Commissioner will contract with a consultant to review formularies for Affordable Care Act (ACA) compliant plans for 2019 and 2020 plan years. The consultant will assist West Virginia in the review of individual and small group markets for compliance with state and federal laws, guidance and federal nondiscrimination standards. The consultant will identify common mental health and substance use disorders at risk of potentially discriminatory formulary designs and add the identified disorders to the CMS Formulary Review Suite Non-Discrimination Clinical Appropriateness tool. West Virginia will also collect documentation from insurers to evaluate compliance with parity of non-quantitative treatment limits, including a formulary exception process, applied to prescription drugs for the treatment of the mental health and substance used disorder conditions under review.