Like many other states, West Virginia was prompted to develop an Emergency Management System by an act of Congress. In 1996, Congress enacted the National Highway Safety Act, which created the Department of Transportation (DOT) with a mandate to establish minimum standards for provision of care for accident victims, including the development and implementation of training standards for EMS personnel. DOT was authorized to withhold up to 10 percent of a state's federal highway funds if the state did not comply with the standards.

West Virginia responded with the ?Emergency Ambulance Service Act of 1975,? which created the Office of Emergency Medical Services, mandated to report organizationally to the West Virginia Office of Community Health Systems within the Bureau for Public Health of the West Virginia Department of Health and Human Resources.

In 1996, the State Legislature passed W. Va. Code 33-25-8d, which requires that health insurance policies include coverage for emergency services, with the same deductibles, coinsurance and other limitations as apply to other covered services. Insurance companies cannot require preauthorization or pre-certification.

In 1997, the legislature established a wireless enhanced 911 fee to help offset the cost to counties for their 911 emergency telephone systems. The fee was set at $.75 per month for each valid retail commercial mobile radio service subscription. The Public Service Commission was mandated to recalculate the fee every two years after conducting an audit.

In 1998, the legislature provided a detailed and standardized definition of emergency services under the types of services that various health insurers and health care organizations are required to cover. The new definition included services provided in or by an ambulance and other pre-hospital services to the extent necessary to screen and stabilize the covered person. The act provided detailed procedures for the coverage of emergency services, including a prudent layperson standard for use in determining if coverage should be provided.

The State Legislature changed the name of the Office of Emergency Medical Services to the Division of Homeland Security and Emergency Management in 2005 with W. Va. Act No. 122, which also mandated that the Division coordinate with the Department of Military Affairs and Public Safety.

In 2005, the legislature also raised the fee for wireless enhanced 911 and adjusted the formula by which the Public Service Commission distributes the revenues from the fee to the counties. The legislation also earmarked an amount for construction of wireless towers, created the Enhanced 911 Wireless Tower Assistance Fund to be administered by the Public Service Commission, and allowed counties which consolidate government services to receive one percent of the fee for each county consolidated.