The commission may establish by rule or order maximum rates and service limitations for reimbursement of health care services rendered by a physician, hospital, or other health care provider. An informational copy of the maximum rates and service limitations shall be filed with the Joint Committee on Government and Finance upon adoption by the commission. Any change in the maximum rates or service limitations shall be effective sixty days after the adoption of the changes. A provider who accepts payment from the commission for a service shall accept the commission’s rates as payment in full and may not accept any payment on account of the service from any other source if the total of payments accepted would exceed the maximum rate set by the commission for that service. A provider may not charge a claimant for any difference between the cost of a service provided to a claimant and the commission’s payment for that service. To ensure service limitations are uniform and appropriate to the levels of treatment required by the claimant, the commission may review all claims for these services as necessary to ensure their medical necessity.
West Virginia Legal Code