Shown verbatim: the complete text as captured from the official PDF posted by the West Virginia Legislature, fetched 2026-09-25. Page and line markers are part of the official record; nothing is edited or removed. The official bill page.
WEST VIRGINIA LEGISLATURE
2026 REGULAR SESSION
ENROLLED
Committee Substitute
for
House Bill 4335
BY DELEGATES WORRELL AND HITE
[Passed February 20, 2026; in effect from passage]
Enr CS for HB 4335
1 AN ACT to amend the Code of West Virginia, 1931, as amended, by adding a new section,
2 designated §9-5-34; and to repeal §16-1A-1, §16-1A-2, §16-1A-3, §16-1A-4, §16-1A-5,
3 §16-1A-6, §16-1A-7, §16-1A-8, §16-1A-9, and §16-1A-10, relating to Medicaid providers;
4 establishing expedited enrollment timelines for the state’s fiscal agent; establishing a
5 uniform credentialing requirement for managed care organizations; establishing timelines;
6 allowing penalties; setting forth duties of Insurance Commissioner; requiring use of form;
7 requiring the exclusive use of electronic submissions; and removing duplicative uniform
8 credentialing requirements.
Be it enacted by the Legislature of West Virginia:
CHAPTER 9. HUMAN SERVICES
ARTICLE 5. MISCELLANEOUS PROVISIONS.
§9-5-34. Medicaid provider enrollment and credentialing; expedited timelines; electronic
submission; and unified system.
1 (a) By July 1, 2026, the Department of Human Services or its agent shall complete
2 enrollment determinations for Medicaid providers within five business days of receipt of a
3 completed application.
4 (1) The department or its agent shall permit multiple people to be logged into the system.
5 (2) The agent shall be accredited by the National Committee for Quality Assurance.
6 (3) In the event that required documentation is incomplete, the applicant shall be notified
7 electronically within two business days with a detailed explanation of the missing materials and
8 provided a secure link to submit missing materials.
9 (4) Failure of the agent to meet the enrollment standard shall be reportable to the
10 department and included in quarterly performance audits.
11 (b)(1) By July 1, 2026, a Medicaid managed care organization shall complete provider
12 credentialing within 60 calendar days of receipt of a clean and complete application.
1
Enr CS for HB 4335
13 (2) A Medicaid managed care organization may request a one-time extension of no more
14 than 30 days, only upon written justification to the department and notice to the applicant.
15 (3) Upon failure to meet required timelines, a Medicaid managed care organization shall
16 be subject to penalties established in the contract, including corrective action plans, monetary
17 sanctions, or credentialing-by-default at the discretion of the department.
18 (c) (1) By July 1, 2026, the Office of the Insurance Commissioner shall prescribe the
19 credentialing application form used by the Council for Affordable Quality Healthcare in electronic
20 format. The standard credentialing form shall be as simple, straightforward, and easy to use as
21 possible, having due regard for those credentialing forms that are widely in use in the state by the
22 Medicaid managed care organizations and that best serve these goals.
23 (2) A Medicaid managed care organization may not fail to use the applicable standard
24 credentialing form when initially credentialing or recredentialing providers in connection with
25 policies, health care contracts, and agreements providing basic health care services, specialty
26 health care services, or supplemental health care services.
27 (3) A Medicaid managed care organization may not require a provider to provide any
28 information in addition to the information required by the applicable standard credentialing form
29 in connection with policies, health care contracts, and agreements providing basic health care
30 services, specialty health care services, or supplemental health care services.
31 (4) The credentialing process described in this section does not prohibit a Medicaid
32 managed care organization from limiting the scope of any participating provider's basic health
33 care services, specialty health care services, or supplemental health care services.
34 (d) Beginning July 1, 2026, enrollment and credentialing applications, renewals,
35 documents, and supporting materials submitted by providers participating in Medicaid or a
36 Medicaid managed care plan shall be submitted exclusively by electronic means.
2
Enr CS for HB 4335
CHAPTER 16. PUBLIC HEALTH.
ARTICLE 1A. UNIFORM CREDENTIALING FOR HEALTH CARE PRACTITIONERS.
§16-1A-1. Legislative findings; purpose.
1 [Repealed.]§16-1A-2. Development of uniform credentialing application forms and the
2 credentialing process.
3 [Repealed.]§16-1A-3. Definitions.
4 [Repealed.]
§16-1A-4. Advisory committee.
1 [Repealed.]
§16-1A-5. Credentialing Verification Organization.
1 [Repealed.]
§16-1A-6. Contract with statewide credentialing verification organization; requirements.
1 [Repealed.]
§16-1A-7. Verification process; suspension of requirements.
1 [Repealed.]
§16-1A-8. Release and uses of information collected; confidentiality.
1 [Repealed.] §16-1A-9. Rulemaking; fees; penalties.
2 [Repealed.]
§16-1A-10. Immunity.
1 [Repealed.]
3
Enr CS for HB 4335
The Clerk of the House of Delegates and the Clerk of the Senate hereby
certify that the foregoing bill is correctly enrolled.
...............................................................
Clerk of the House of Delegates
...............................................................
Clerk of the Senate
Originated in the House of Delegates.
In effect from passage.
...............................................................
Speaker of the House of Delegates
...............................................................
President of the Senate
__________
The within is ................................................ this the...........................................
Day of ..........................................................................................................., 2026.
.............................................................
Governor
5Every fact on this page links to its source, starting with the official bill record.