{"data":{"id":"us-wv/w.-va.-code-33-15-4x","jurisdiction":"us-wv","citation":"W. Va. Code § 33-15-4x","heading":"Coverage of emergency medical services to triage and transport to alternative destination or treat in place.","body":"(a) The following terms are defined:\n(1) \"911 call\" means a communication indicating that an individual may need emergency medical services;\n(2) \"Alternative destination\" means a lower-acuity facility that provides medical services, including without limitation:\n(A) A federally-qualified health center;\n(B) An urgent care center;\n(C) A rural health clinic;\n(D) A physician office or medical clinic as selected by the patient; and\n(E) A behavioral or mental health care facility including, without limitation, a crisis stabilization unit.\n\"Alternative destination\" does not include a:\n(A) Critical access hospital;\n(B) Dialysis center;\n(C) Hospital;\n(D) Private residence; or\n(E) Skilled nursing facility;\n(3) \"Emergency medical services agency\" means any agency licensed under §16-4C-6a of this code to provide emergency medical services: Provided, That rotary and fixed wing air ambulances are specifically excluded from the definition of an emergency medical services agency;\n(4) \"Medical command\" means the issuing of orders by a physician from a medical facility to emergency medical services personnel for the purpose of providing appropriate patient care; and\n(5) \"Telehealth services\" means the use of synchronous or asynchronous telecommunications technology or audio-only telephone calls by a health care practitioner to provide health care services, including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. The term does not include e-mail messages or facsimile transmissions.\n(b) An insurer which issues or renews a health insurance policy on or after January 1, 2025, shall provide coverage for:\n(1) An emergency medical services agency to:\n(A) Treat an enrollee in place if the ambulance service is coordinating the care of the enrollee through telehealth services with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint;\n(B) Triage or triage and transport an enrollee to an alternative destination if the ambulance service is coordinating the care of the enrollee through telehealth services with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint; or\n(C) An encounter between an ambulance service and enrollee that results in no transport of the enrollee if:\n(i) The enrollee declines to be transported against medical advice; and\n(ii) The emergency medical services agency is coordinating the care of the enrollee through telehealth services or medical command with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint.\n(c) The coverage under this section:\n(1) Only includes emergency medical services transportation to the treatment location;\n(2) Is subject to the initiation of response, triage, and treatment as a result of a 911 call that is documented in the records of the emergency medical services agency;\n(3) Is subject to deductibles or copayment requirements of the policy, contract, or plan;\n(4) Does not diminish or limit benefits otherwise allowable under a health benefit plan, even if the billing claims for medical or behavioral health services overlap in time that is billed by the ambulance service also providing care; and\n(5) Does not include rotary or fixed wing air ambulance services.\n(d) The reimbursement rate for an emergency medical services agency that triages, treats, and transports a patient to an alternative destination, or triages, treats, and does not transport a patient, if the patient declines to be transported against medical advice, if the ambulance service is coordinating the care of the enrollee through medical command or telemedicine with a physician for a medical-based complaint, or with a behavioral health specialist for a behavioral-based complaint under this section, shall be reimbursed at the same rate as if the patient were transported to an emergency room of a facility provider.","path":["CHAPTER 33. INSURANCE.","ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE."],"source_url":"https://code.wvlegislature.gov/33-15-4X/","current_through":"as of 2026-08-03; contains at least the enactments of the 2026 Regular Session","vintage":"","retrieved_at":"2026-09-06T00:28:31Z","sha256":"4742c5b0434e35995b79bf51f6d8492eba613d5025a07efde499378070175e4d","source_id":"us-wv","stale":true,"prev":"us-wv/w.-va.-code-33-15-4w","next":"us-wv/w.-va.-code-33-15-5"},"notice":"GroundRules: Original legal text. Not legal advice."}