RESIDENTIAL SUPPORT SERVICES PROVIDER IN WEST VIRGINIA
PROVIDING 24/7 SUPERVISION AND SUPPORT TO INDIVIDUALS IN COMMUNITY LIVING SETTINGS TO PROMOTE SAFETY, STABILITY, AND INDEPENDENCE

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Residential Support Services in West Virginia deliver comprehensive care and supervision to individuals who require assistance with daily living in licensed or certified residential settings. These services ensure that participants can live safely in the community rather than in institutional facilities.

Residential support is a Medicaid waiver service, primarily offered under the Intellectual/Developmental Disabilities (I/DD) Waiver and the Children with Serious Emotional Disorder Waiver (CSEDW). These programs are overseen by the West Virginia Department of Health and Human Resources (WVDHHR) and the Bureau for Medical Services (BMS).

1. GOVERNING AGENCIES

Agency: West Virginia Department of Health and Human Resources (WVDHHR)
Role: Administers and regulates waiver services, including residential programs.

Agency: Bureau for Medical Services (BMS)
Role: Oversees Medicaid provider enrollment and compliance monitoring.

Agency: Office of Health Facility Licensure & Certification (OHFLAC)
Role: Licenses residential settings that provide health-related services or overnight supervision.

2. RESIDENTIAL SUPPORT SERVICES OVERVIEW

Residential Support Services provide supervised living arrangements where trained staff assist individuals with personal care, skill-building, medication oversight, and behavioral support.

Services may include:

24/7 supervision and personal care

Assistance with ADLs and IADLs

Medication administration or assistance

Support with meal prep, housekeeping, and hygiene

Behavioral redirection and skill reinforcement

Transportation coordination for appointments and activities

Social and recreational engagement

Documentation and progress reporting

These services are delivered in licensed homes, apartments, or group living environments, depending on the participant’s needs and the waiver program.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your agency with the WV Secretary of State

Obtain a Federal EIN and Type 2 NPI

Apply for Medicaid enrollment via Gainwell Technologies

Submit an application to become a Residential Services Provider under the I/DD Waiver

If providing medical oversight or overnight care, obtain a license from OHFLAC

Develop a Residential Support Services Policy & Procedure Manual

Establish staffing plans with required training and supervision

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN and NPI
Step 2: Apply to WVDHHR as a waiver-approved residential provider
Step 3: Submit Medicaid provider application via Gainwell Technologies
Step 4: If required, apply for OHFLAC licensure
Step 5: Complete background checks and staff training
Step 6: Submit Policy & Procedure Manual for approval
Step 7: Begin operations once approved and authorized in ISP

5. REQUIRED DOCUMENTATION

WV business registration and NPI

Medicaid provider agreement and waiver program approval

OHFLAC facility license (if applicable)

Residential Support Services Policy & Procedure Manual including:

Admission, discharge, and service coordination policies

Emergency protocols, staffing schedules, and supervision plans

Medication assistance and safety protocols

Participant rights, grievance procedures, and HIPAA compliance

Fire safety, infection control, and physical environment standards

Incident reporting and documentation templates

Behavioral support and crisis de-escalation procedures

6. STAFFING REQUIREMENTS

Role: Direct Support Professional (DSP)
Requirements:

18+ years of age

WV CARES background check

Trained in CPR/First Aid, abuse prevention, documentation, and emergency procedures

Role: Residential Supervisor / Program Manager
Responsibilities: Oversees daily operations, staff performance, and ISP implementation

Role: Nurse (if providing medication administration)
Requirement: Licensed RN or LPN; may be required depending on participant needs and level of care

All staff must complete:

Annual training and skills assessments

HIPAA and participant rights training

Safety and crisis management training

Documentation and shift reporting

7. MEDICAID WAIVERS THAT COVER RESIDENTIAL SUPPORT

I/DD Waiver – Provides comprehensive residential services for individuals with developmental disabilities

CSEDW (Children with Serious Emotional Disorder Waiver) – May include residential placements for children

TBIW (Traumatic Brain Injury Waiver) – On a case-by-case basis for individuals needing community living support

Note: Each participant must have an approved ISP that justifies the level of residential care needed.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Enrollment Preparation
Timeline: 2–4 weeks

Phase: Medicaid & Waiver Application Submission
Timeline: 1–2 months

Phase: OHFLAC Licensure & Site Readiness (if applicable)
Timeline: 1–2 months

Phase: Staff Hiring & Training
Timeline: 3–5 weeks

Phase: Launch of Services
Timeline: Begins once provider approval and ISP authorizations are in place

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

Office of Health Facility Licensure & Certification (OHFLAC)
Website: https://ohflac.wv.gov

WV Secretary of State – Business Registration
Website: https://sos.wv.gov

Gainwell Technologies – WV Medicaid Enrollment
Website: https://www.wvmmis.com

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA RESIDENTIAL SUPPORT PROVIDER
WCG helps agencies develop licensed, Medicaid-approved residential programs that meet state staffing, safety, and quality assurance standards.

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Scope of Work:

Waiver and Medicaid enrollment assistance

Residential Support Services P&P Manual development

ISP implementation tools and documentation templates

Staff training plans, credentialing packets, and shift logs

Safety plans, fire drills, and incident report forms

Billing setup and documentation compliance

CRISIS SERVICES PROVIDER IN WEST VIRGINIA
RESPONDING TO EMERGENCIES WITH STABILIZATION, DE-ESCALATION, AND SUPPORT FOR INDIVIDUALS EXPERIENCING BEHAVIORAL OR MEDICAL CRISES IN COMMUNITY SETTINGS

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Crisis Services in West Virginia provide immediate, short-term interventions to stabilize individuals experiencing a behavioral, emotional, or situational crisis. These services aim to reduce the risk of hospitalization, arrest, or out-of-home placement by managing crises in the least restrictive environment possible.

These services are offered under Medicaid waivers such as the Intellectual/Developmental Disabilities (I/DD) Waiver and the Children with Serious Emotional Disorder Waiver (CSEDW), as well as through behavioral health programs supported by the Bureau for Behavioral Health (BBH) and Bureau for Medical Services (BMS). Services must align with an individual’s Person-Centered Service Plan (PCSP) or Behavior Support Plan (BSP) when applicable.

1. GOVERNING AGENCIES

Agency: West Virginia Department of Health and Human Resources (WVDHHR)
Role: Oversees crisis system infrastructure and waiver integration.

Agency: Bureau for Medical Services (BMS)
Role: Administers Medicaid coverage and ensures provider compliance with billing and authorization protocols.

Agency: Bureau for Behavioral Health (BBH)
Role: Oversees crisis response program design and behavioral health integration.

Agency: Acentra Health (formerly Kepro)
Role: Approves crisis services as part of PCSPs/ISPs and monitors utilization.

2. CRISIS SERVICES OVERVIEW

Crisis Services support individuals who are experiencing acute behavioral distress, medical instability, or disruptive episodes requiring immediate intervention. Services may be mobile, telephonic, or site-based.

Common components include:

Mobile Crisis Response (in-home, on-site, or community-based)

Behavioral De-escalation and Safety Planning

Mental Health Crisis Intervention

Medical Stabilization and Observation

24/7 Crisis Hotlines and Response Coordination

Short-Term Crisis Residential Placement

Caregiver support and education during crisis

Linkage to long-term supports and behavioral services

Crisis intervention must be documented and reported within defined timeframes and authorized by the individual's service plan team or emergency protocols.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the WV Secretary of State

Obtain EIN and Type 2 NPI

Apply as a Crisis Services provider under the I/DD Waiver or behavioral health designation

Enroll as a Medicaid provider through Gainwell Technologies

Secure appropriate staff licenses (e.g., LSW, LPC, RN, BCBA) based on service model

Submit a Crisis Services Policy & Procedure Manual

If offering residential crisis beds, apply for OHFLAC licensure

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your organization and obtain NPI and EIN
Step 2: Apply to WVDHHR as a Crisis Services provider
Step 3: Enroll as a Medicaid provider via Gainwell Technologies
Step 4: Submit Policy & Procedure Manual detailing crisis response protocols
Step 5: Hire or contract credentialed clinicians and response staff
Step 6: Launch services after provider approval and waiver authorization

5. REQUIRED DOCUMENTATION

WV business registration and Medicaid provider ID

Crisis Services Policy & Procedure Manual including:

24/7 availability and on-call coverage plans

Clinical risk assessment protocols

Incident debriefing and care transition processes

Behavioral and safety crisis intervention models (e.g., CPI, MANDT)

HIPAA and participant rights safeguards

Training, supervision, and staff credentialing logs

Communication and reporting timelines for emergency events

Crisis documentation, billing, and ISP/PCSP tracking templates

6. STAFFING REQUIREMENTS

Role: Crisis Intervention Specialist / Clinician
Requirements:

Licensed mental health or behavioral professional (LPC, LICSW, BCBA, RN, etc.)

Trained in de-escalation and crisis intervention (e.g., CPI-certified)

Role: Direct Care / Crisis Support Staff
Requirements:

Background check through WV CARES

Trained in emergency response, documentation, and person-centered care

Role: Crisis Coordinator / Supervisor
Responsibilities:

Ensures 24/7 coverage, oversees response quality, supervises staff

All staff must complete:

HIPAA and confidentiality training

Abuse prevention and mandated reporter training

Emergency response and documentation protocols

Annual skills validation and behavioral health competencies

7. MEDICAID PROGRAMS THAT COVER CRISIS SERVICES

I/DD Waiver – Authorizes crisis response and behavioral supports when listed in the PCSP

CSEDW – Covers crisis intervention for children with serious emotional or behavioral challenges

Behavioral Health State Plan Services – May apply if services are not waiver-specific

TBIW – May allow crisis coverage for eligible incidents with proper documentation

All crisis services must be authorized and billed in accordance with Medicaid and waiver-specific rules.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Staffing Plan Development
Timeline: 2–4 weeks

Phase: Medicaid Enrollment & Crisis Manual Preparation
Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, & Crisis Protocol Setup
Timeline: 30–45 days

Phase: Launch of Services
Timeline: Begins upon approval and PCSP/ISP authorization

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

Bureau for Behavioral Health (BBH)
Website: https://dhhr.wv.gov/BBH

Acentra Health (formerly Kepro)
Website: https://wv.acentra.com

Office of Health Facility Licensure & Certification (OHFLAC)
Website: https://ohflac.wv.gov

Gainwell Technologies – Medicaid Enrollment
Website: https://www.wvmmis.com

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA CRISIS SERVICES PROVIDER
WCG helps behavioral health and disability service providers launch crisis response programs with full policy support, credentialing workflows, and Medicaid readiness.

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Scope of Work:

Waiver application and Medicaid enrollment guidance

Crisis Response Policy & Procedure Manual compliant with WV waiver and behavioral standards

Staff credentialing packets and training schedules

Emergency response logs, incident report templates, and care transition forms

HIPAA and de-escalation protocols

Billing tools and audit-ready documentation support

PERSONAL ATTENDANT SERVICES PROVIDER IN WEST VIRGINIA
ENABLING INDEPENDENT LIVING FOR ELIGIBLE ADULTS THROUGH DAILY SUPPORT WITH ACTIVITIES OF DAILY LIVING IN HOME SETTINGS

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Personal Attendant Services (PAS) in West Virginia offer non-medical, hands-on assistance to Medicaid-eligible individuals who are aged or disabled and require help with daily living tasks to remain in their homes. These services are primarily covered under the Aged and Disabled Waiver (ADW), administered by the West Virginia Department of Health and Human Resources (WVDHHR) in partnership with the Bureau for Medical Services (BMS).

PAS may be delivered by agency-employed attendants or via a self-directed option known as Personal Options, empowering individuals to hire and manage their own care workers.

1. GOVERNING AGENCIES

Agency: West Virginia Department of Health and Human Resources (WVDHHR)
Role: Administers the ADW and regulates provider standards, eligibility, and oversight.

Agency: Bureau for Medical Services (BMS)
Role: West Virginia’s Medicaid agency responsible for processing provider enrollment, claims, and funding.

Agency: Acentra Health (formerly Kepro)
Role: Handles participant assessments, medical eligibility, and quality reviews for ADW programs.

2. PERSONAL ATTENDANT SERVICES OVERVIEW

Services are individualized and based on functional need, as documented in a Person-Centered Service Plan (PCSP). Covered services may include:

Bathing, grooming, and dressing assistance

Toileting and incontinence care

Mobility support and transferring

Meal preparation and feeding

Light housekeeping (essential to the participant’s health)

Laundry and linen changing

Medication reminders (non-administration)

Accompanying participants to appointments or errands (non-medical)

All services must be prior authorized and documented according to ADW and Medicaid standards.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your agency with the WV Secretary of State

Obtain a Federal EIN and Type 2 NPI

Submit an ADW Personal Attendant Agency Application to WVDHHR

Complete Medicaid enrollment with Gainwell Technologies (Medicaid fiscal agent)

Hire or contract with a licensed Registered Nurse (RN) for care planning and supervisory duties

Submit a Policy & Procedure Manual that meets ADW service standards

Maintain worker’s compensation, general liability, and fidelity insurance

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Complete business registration, obtain EIN and NPI
Step 2: Submit ADW Personal Attendant agency application
Step 3: Complete Medicaid provider enrollment via Gainwell Technologies
Step 4: Submit P&P Manual and staff credentialing documents
Step 5: Pass readiness inspection and onboarding audit (if applicable)
Step 6: Begin accepting participant referrals through case managers and Acentra

5. REQUIRED DOCUMENTATION

WV Secretary of State business registration

Approved Medicaid provider contract

Signed Attendant Agency agreement with WVDHHR

Personal Attendant Policy & Procedure Manual including:

Client intake and service authorization workflow

Staff roles, training, and supervision by RN

Emergency procedures and incident reporting

Documentation standards (e.g., shift notes, time logs)

HIPAA compliance and abuse prevention protocols

Grievance resolution and participant rights statements

EVV system utilization (electronic visit verification)

6. STAFFING REQUIREMENTS

Role: Personal Attendant (PA)
Requirements:

Must be 18+ years old

Pass WV CARES background check

Complete initial and ongoing training (CPR, universal precautions, abuse prevention)

Capable of assisting with ADLs independently

Role: Registered Nurse (RN) Supervisor
Requirements:

Current WV license

Reviews PCSPs, conducts participant assessments, supervises PAs

Role: Program Administrator (for agency model)
Responsibilities: Oversees compliance, scheduling, documentation, and personnel files

All staff must complete:

Orientation and annual competency evaluations

Ongoing continuing education (as required)

EVV training and documentation compliance

7. MEDICAID WAIVER PROGRAMS THAT COVER PERSONAL ATTENDANT SERVICES

Aged and Disabled Waiver (ADW) – Primary funding source for PAS

Personal Options (Self-Directed ADW Option) – Allows participants to recruit and manage their own attendants

State Plan Personal Care – May serve individuals on Medicaid but not ADW

Community First Choice Option (CFC) – Not yet implemented in WV but may include similar services in the future

All services require prior approval based on Acentra Health’s functional assessment.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Application Submission
Timeline: 2–4 weeks

Phase: Medicaid Enrollment & Documentation Setup
Timeline: 4–6 weeks

Phase: RN Oversight & Staff Credentialing
Timeline: 30–45 days

Phase: Launch of Services
Timeline: Upon approval and authorization of initial service plans

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

WV Secretary of State Business Registration
Website: https://sos.wv.gov

Gainwell Technologies (Medicaid Enrollment Portal)
Website: https://www.wvmmis.com

Acentra Health (formerly Kepro)
Website: https://wv.acentra.com

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA PERSONAL ATTENDANT PROVIDER
WCG assists providers in launching Medicaid-compliant Personal Attendant agencies, guiding you through documentation, staff setup, and billing readiness.

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Scope of Work:

Business registration and Medicaid enrollment support

ADW-compliant Policy & Procedure Manual

RN supervision protocols and care plan templates

Staff hiring documents, training logs, and timekeeping tools

Participant intake, grievance, and HIPAA forms

EVV documentation and billing workflow setup

PERSONAL EMERGENCY RESPONSE SYSTEM (PERS) PROVIDER IN WEST VIRGINIA
PROVIDING 24/7 MONITORED ALERT DEVICES TO HELP VULNERABLE INDIVIDUALS LIVE SAFELY AND INDEPENDENTLY IN THEIR OWN HOMES

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Personal Emergency Response Systems (PERS) are electronic devices that allow individuals to quickly summon help in an emergency. Commonly used by older adults and individuals with disabilities, these systems are vital for people at risk of falls, sudden illness, or living alone. In West Virginia, PERS is a covered service under Medicaid waiver programs, especially the Aged and Disabled Waiver (ADW) and Traumatic Brain Injury Waiver (TBIW).

Oversight is provided by the West Virginia Department of Health and Human Resources (WVDHHR) and the Bureau for Medical Services (BMS), with prior authorization and utilization review handled by Acentra Health (formerly Kepro).

1. GOVERNING AGENCIES

Agency: West Virginia Department of Health and Human Resources (WVDHHR)
Role: Manages Medicaid waiver programs and PERS provider oversight.

Agency: Bureau for Medical Services (BMS)
Role: Processes provider enrollment, billing, and PERS policy compliance.

Agency: Acentra Health (formerly Kepro)
Role: Conducts functional assessments, approves service plans, and authorizes PERS use.

2. PERSONAL EMERGENCY RESPONSE SYSTEM SERVICES OVERVIEW

PERS provides 24/7 access to emergency support. Participants wear a pendant or wristband with an alert button that connects them to a response center, which dispatches emergency services or a designated caregiver.

Covered services may include:

Installation of the electronic unit and wearable alert device

24/7 monitoring by a certified emergency response center

Maintenance, testing, and equipment replacement

Caregiver or emergency contact notifications

Optional fall detection technology

PERS must be listed in the Person-Centered Service Plan (PCSP) or Individual Service Plan (ISP) as medically necessary to prevent institutionalization.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the WV Secretary of State

Obtain an EIN and Type 2 NPI

Enroll as a Medicaid waiver provider through Gainwell Technologies

Submit a PERS provider application to BMS or waiver-specific program

Establish a contract with a 24/7 emergency monitoring center

Develop a PERS Services Policy & Procedure Manual

Ensure staff receive training on equipment setup, documentation, and HIPAA compliance

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN and NPI
Step 2: Submit provider enrollment to BMS via Gainwell Technologies
Step 3: Submit application to provide PERS under the applicable waiver (e.g., ADW, TBIW)
Step 4: Provide documentation for monitoring center partnership and backup systems
Step 5: Submit Policy & Procedure Manual for review
Step 6: Begin accepting referrals upon approval and ISP/PCSP authorization

5. REQUIRED DOCUMENTATION

Business registration and Medicaid provider ID

Agreement with certified 24/7 emergency monitoring center

Medicaid waiver authorization from Acentra (participant-specific)

Policy & Procedure Manual including:

Installation protocols and user education

Device maintenance and monitoring standards

Emergency call response workflows

Equipment failure procedures and replacement timelines

HIPAA and client privacy policies

Incident reporting and documentation templates

Monthly service logs and billing records

6. STAFFING REQUIREMENTS

Role: PERS Technician / Installer
Requirements:

Trained in device installation, troubleshooting, and participant instruction

HIPAA compliant and capable of documenting service provision

Background check through WV CARES

Role: Monitoring Center Operator (external or subcontracted)
Requirements:

Available 24/7/365

Certified to respond to medical and non-medical alerts

Must maintain documentation logs and emergency response records

All staff must complete:

HIPAA and abuse prevention training

Emergency response training

Documentation and billing standards orientation

Annual policy and safety reviews

7. MEDICAID PROGRAMS THAT COVER PERS

Aged and Disabled Waiver (ADW) – When PERS is necessary to support community living

Traumatic Brain Injury Waiver (TBIW) – For individuals with memory, mobility, or cognitive impairments

Other waiver programs on a case-by-case basis, based on risk and ISP/PCSP recommendations

Note: PERS may not be reimbursed under State Plan Medicaid outside of a waiver program.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Medicaid Enrollment
Timeline: 2–4 weeks

Phase: Monitoring Center Partnership & Manual Development
Timeline: 2–3 weeks

Phase: Documentation Submission & Authorization Approval
Timeline: 1–2 months

Phase: Service Launch
Timeline: Begins once referrals are received and ISP/PCSP authorization is issued

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

Acentra Health (formerly Kepro)
Website: https://wv.acentra.com

WV Secretary of State Business Portal
Website: https://sos.wv.gov

Gainwell Technologies (Medicaid Enrollment)
Website: https://www.wvmmis.com

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA PERS PROVIDER
WCG supports providers in launching Personal Emergency Response System services that meet waiver documentation, monitoring, and billing standards.

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Scope of Work:

Medicaid enrollment and waiver application support

PERS Policy & Procedure Manual development

Monitoring center partnership templates and MOU setup

Staff training materials and equipment installation guides

HIPAA forms, incident tracking, and service log templates

Billing guidance and service documentation tools

SKILLED NURSING SERVICES PROVIDER IN WEST VIRGINIA
DELIVERING CLINICAL CARE AND MEDICATION MANAGEMENT TO INDIVIDUALS IN HOME AND COMMUNITY SETTINGS UNDER MEDICAL SUPERVISION

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Skilled Nursing Services in West Virginia provide medically necessary, licensed nursing care to individuals with chronic conditions, disabilities, or post-acute recovery needs. These services include wound care, injections, medication management, and clinical monitoring, delivered in home or community-based settings to prevent hospitalization or institutionalization.

These services are covered under West Virginia Medicaid, including State Plan benefits and Home and Community-Based Services (HCBS) waivers such as the Aged and Disabled Waiver (ADW) and the Intellectual/Developmental Disabilities (I/DD) Waiver. Oversight is provided by the Bureau for Medical Services (BMS) and the Office of Health Facility Licensure & Certification (OHFLAC).

1. GOVERNING AGENCIES

Agency: West Virginia Bureau for Medical Services (BMS)
Role: Administers Medicaid reimbursement for skilled services and oversees provider enrollment.

Agency: Office of Health Facility Licensure & Certification (OHFLAC)
Role: Licenses home health agencies and skilled nursing providers for safety, clinical standards, and legal compliance.

Agency: Acentra Health (formerly Kepro)
Role: Conducts utilization reviews, authorizations, and participant assessments for Medicaid waiver services.

2. SKILLED NURSING SERVICES OVERVIEW

Skilled Nursing is intermittent, physician-directed care delivered by a Registered Nurse (RN) or Licensed Practical Nurse (LPN) under RN supervision. Covered services may include:

Wound care and dressing changes

Tube feeding (enteral nutrition)

Medication setup, injections, or IV therapy

Catheter care and management

Blood sugar monitoring and insulin administration

Tracheostomy and ventilator care (case-specific)

Chronic condition management (e.g., CHF, COPD, diabetes)

Clinical documentation and vital sign monitoring

Patient and caregiver education

All services must be authorized in the Individual Service Plan (ISP) or Person-Centered Service Plan (PCSP) and ordered by a licensed physician.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the WV Secretary of State

Obtain EIN and Type 2 NPI

Apply for OHFLAC licensure as a Home Health Agency or specialized Skilled Nursing provider

Complete Medicaid provider enrollment via Gainwell Technologies

Submit Policy & Procedure Manual per OHFLAC and BMS guidelines

Employ licensed RNs and LPNs

Maintain malpractice, liability, and worker’s compensation insurance

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN and NPI
Step 2: Apply for OHFLAC licensure and schedule inspection
Step 3: Submit provider enrollment forms to Gainwell Technologies
Step 4: Develop skilled nursing policies and forms per CMS and OHFLAC
Step 5: Credential nursing staff and ensure RN supervision protocols
Step 6: Launch services once authorized in client service plans

5. REQUIRED DOCUMENTATION

OHFLAC license as a Home Health Agency or Nursing provider

WV Medicaid enrollment confirmation

Skilled Nursing Policy & Procedure Manual including:

Physician order tracking and plan of care documentation

Medication administration and vital sign logs

Infection control, hand hygiene, and universal precautions

RN delegation procedures (if using LPNs)

Emergency response and on-call coverage plans

Patient rights, HIPAA compliance, and grievance resolution

Incident reporting and adverse event documentation

Nurse credentialing and annual competency evaluations

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements:

Licensed by the WV Board of Examiners for Registered Professional Nurses

Responsible for assessments, care planning, oversight of LPNs

Role: Licensed Practical Nurse (LPN)
Requirements:

Licensed by the WV Board of Examiners for Licensed Practical Nurses

May perform delegated tasks under RN supervision

Role: Clinical Supervisor / Administrator
Responsibilities: Oversees staff compliance, care plans, audits, and safety

All staff must complete:

HIPAA and patient confidentiality training

Infection control and universal precautions

Emergency response and incident documentation

Annual skills assessments and CEU tracking

Abuse prevention and mandatory reporter training

7. MEDICAID PROGRAMS THAT COVER SKILLED NURSING

Skilled Nursing may be reimbursed under:

State Plan Home Health Services – Requires physician order and prior authorization

Aged and Disabled Waiver (ADW) – For adults 18+ needing nursing as part of their PCSP

I/DD Waiver – For individuals with developmental disabilities requiring intermittent clinical care

Medically Fragile Children’s Services – Pediatric-focused nursing services

Traumatic Brain Injury Waiver (TBIW) – Case-by-case skilled care support

All services must be listed in the approved service plan.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Licensure Preparation
Timeline: 2–3 weeks

Phase: OHFLAC Application & Inspection
Timeline: 1–2 months

Phase: Medicaid Enrollment & Staff Credentialing
Timeline: 30–45 days

Phase: Launch of Services
Timeline: Begins upon approval and authorization in ISP/PCSP

9. CONTACT INFORMATION

WV Office of Health Facility Licensure & Certification (OHFLAC)
Website: https://ohflac.wv.gov

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

Gainwell Technologies – WV Medicaid Enrollment
Website: https://www.wvmmis.com

WV RN Board
Website: https://wvrnboard.wv.gov

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA SKILLED NURSING PROVIDER
WCG helps agencies launch compliant skilled nursing programs, guiding you from licensure to documentation and service delivery.

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Scope of Work:

OHFLAC licensing and Medicaid enrollment assistance

Skilled Nursing Policy & Procedure Manual compliant with WV regulations

Plan of Care, physician order, and nurse delegation templates

Infection control logs and emergency protocols

Staff training, credentialing, and documentation tools

EVV setup and billing guidance for Medicaid reimbursement

DAY FACILITY SERVICES PROVIDER IN WEST VIRGINIA
SUPPORTING COMMUNITY ENGAGEMENT, LIFE SKILLS, AND SOCIALIZATION THROUGH STRUCTURED DAY PROGRAMS FOR INDIVIDUALS WITH DISABILITIES

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Day Facility Services in West Virginia offer structured programming during daytime hours for individuals with developmental, intellectual, or behavioral challenges. These programs help participants gain independence, develop new skills, engage socially, and access the community — all while providing family caregivers with reliable daytime support.

These services are typically funded under the Intellectual/Developmental Disabilities (I/DD) Waiver and may also be supported by other specialized waivers. Oversight is provided by the West Virginia Department of Health and Human Resources (WVDHHR) and the Bureau for Medical Services (BMS), with service plan authorization handled by Acentra Health (formerly Kepro).

1. GOVERNING AGENCIES

Agency: West Virginia Department of Health and Human Resources (WVDHHR)
Role: Manages waiver operations and regulates provider standards.

Agency: Bureau for Medical Services (BMS)
Role: Oversees Medicaid funding, waiver billing, and provider credentialing.

Agency: Acentra Health (formerly Kepro)
Role: Authorizes Day Facility Services through the PCSP/ISP and ensures participants receive appropriate care.

Agency: Office of Health Facility Licensure & Certification (OHFLAC)
Role: Licenses day programs providing services to vulnerable adults.

2. DAY FACILITY SERVICES OVERVIEW

Day Facility Services provide skill-building, social interaction, and supervised activities for waiver participants during the day. Services are provided in community-based centers or structured facilities designed to support people with developmental or intellectual disabilities.

Services may include:

Training in activities of daily living (ADLs)

Socialization, recreation, and peer engagement

Community outings and mobility training

Pre-vocational activities and job readiness

Communication and interpersonal skills development

Supervised meals, hygiene assistance, and medication reminders

Behavioral supports and redirection (when outlined in the ISP)

All services must be documented in the Individualized Service Plan (ISP) and focus on person-centered goals.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the WV Secretary of State

Obtain EIN and Type 2 NPI

Enroll as a Medicaid provider via Gainwell Technologies

Apply as a Day Program Provider under the I/DD Waiver

If operating a physical facility, obtain a license from OHFLAC

Develop a comprehensive Policy & Procedure Manual

Meet building, fire safety, and accessibility codes

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain NPI and EIN
Step 2: Apply through WVDHHR to become a Day Facility Services provider under the I/DD Waiver
Step 3: Enroll with Medicaid via Gainwell Technologies
Step 4: Submit your Policy & Procedure Manual and proof of facility readiness
Step 5: Schedule OHFLAC inspection (if required)
Step 6: Hire and train staff per waiver regulations
Step 7: Begin receiving referrals once ISP authorizations are in place

5. REQUIRED DOCUMENTATION

WV business registration and Medicaid provider number

OHFLAC license (if operating a physical day program site)

Day Services Policy & Procedure Manual including:

Daily program schedules and activity plans

Staffing ratios and supervision standards

Participant intake, orientation, and goal tracking

Medication reminder policies and incident reporting

Behavioral support and de-escalation protocols

Emergency evacuation and safety drills

Staff training, credentialing, and supervision logs

Service delivery documentation templates

6. STAFFING REQUIREMENTS

Role: Direct Support Professional (DSP)
Requirements:

18+ years old

WV CARES background check

CPR/First Aid certified

Trained in participant supervision, documentation, and behavioral supports

Role: Day Program Supervisor / Manager
Responsibilities: Oversees day-to-day operations, schedules, and participant progress tracking

Role: Behavior Specialist or Nurse (if applicable)
Requirement: Licensed or credentialed depending on participant needs and service type

All staff must complete:

Annual training in abuse prevention, rights, and HIPAA

Behavioral safety and emergency response training

Documentation and progress note compliance training

7. MEDICAID WAIVERS THAT COVER DAY FACILITY SERVICES

I/DD Waiver – Primary waiver covering Day Habilitation or Day Program Services

CSEDW – May authorize limited structured daytime services for children

TBIW – Case-by-case day service approval depending on participant goals

Services must align with ISP goals and be authorized and billed per waiver guidelines. Daily or hourly billing units are based on participant attendance and staff ratios.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Facility Setup
Timeline: 2–4 weeks

Phase: Medicaid Waiver Application & Manual Submission
Timeline: 1–2 months

Phase: OHFLAC Licensure & Staff Onboarding
Timeline: 30–60 days

Phase: Launch of Services
Timeline: Begins after provider approval and ISP service authorization

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

WV Office of Health Facility Licensure & Certification (OHFLAC)
Website: https://ohflac.wv.gov

Acentra Health (formerly Kepro)
Website: https://wv.acentra.com

Gainwell Technologies – WV Medicaid Enrollment
Website: https://www.wvmmis.com

WV Secretary of State – Business Registration
Website: https://sos.wv.gov

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA DAY FACILITY PROVIDER
WCG helps agencies open compliant day programs with comprehensive documentation, training systems, and waiver-aligned service models.

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Scope of Work:

Medicaid enrollment and waiver application support

Day Facility Services Policy & Procedure Manual development

Daily activity logs, attendance templates, and ISP goal trackers

Staff credentialing systems and annual training schedules

Safety drills, incident forms, and evacuation procedures

Billing documentation and audit readiness tools

EMPLOYMENT SERVICES PROVIDER IN WEST VIRGINIA
SUPPORTING INDIVIDUALS WITH DISABILITIES IN GAINING AND MAINTAINING MEANINGFUL COMPETITIVE EMPLOYMENT THROUGH TAILORED TRAINING AND SUPPORTS

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Employment Services in West Virginia help individuals with disabilities or serious emotional disturbances prepare for, obtain, and succeed in competitive integrated employment. These services focus on person-centered planning, job development, on-the-job support, and workplace accommodations.

These supports are offered under the Intellectual/Developmental Disabilities (I/DD) Waiver, the Children with Serious Emotional Disorder Waiver (CSEDW), and may be coordinated with services through the West Virginia Division of Rehabilitation Services (WVDRS). Oversight is managed by the WV Department of Health and Human Resources (WVDHHR) and the Bureau for Medical Services (BMS), in coordination with Acentra Health for service authorizations.

1. GOVERNING AGENCIES

Agency: West Virginia Department of Health and Human Resources (WVDHHR)
Role: Manages waiver and employment supports for eligible individuals with disabilities.

Agency: Bureau for Medical Services (BMS)
Role: Handles Medicaid billing, provider enrollment, and regulatory compliance.

Agency: Acentra Health (formerly Kepro)
Role: Approves employment services through ISP and monitors plan implementation.

Agency: WV Division of Rehabilitation Services (WVDRS)
Role: May co-fund pre-employment supports and coordinate transition services.

2. EMPLOYMENT SERVICES OVERVIEW

Employment Services include job exploration, skills training, job coaching, placement, and follow-along supports. Services are guided by the Employment First philosophy and must align with the individual’s Person-Centered Service Plan (PCSP) or Individualized Service Plan (ISP).

Covered services include:

Employment Assessment & Job Readiness Training

Career Planning and Exploration

Job Development and Employer Engagement

On-the-Job Coaching and Natural Supports Training

Workplace Accommodations and Disability Disclosure Assistance

Follow-Along Support for Job Retention

Benefits Counseling (in partnership with SSA work incentives programs)

Transportation coordination to/from work

Services are designed to be customized to the individual's strengths, preferences, and vocational goals and must occur in integrated, community-based settings whenever possible.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register as a business with the WV Secretary of State

Obtain a Federal EIN and Type 2 NPI

Apply through BMS to become an Employment Services provider under applicable waiver(s)

Develop a Policy & Procedure Manual for employment supports

Hire or contract qualified employment specialists with appropriate training

Enroll as a Medicaid provider through Gainwell Technologies

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your organization and secure NPI and EIN
Step 2: Apply to BMS for provider approval under the I/DD Waiver or CSEDW
Step 3: Complete Medicaid enrollment via Gainwell Technologies
Step 4: Submit your Employment Services Policy & Procedure Manual
Step 5: Hire or credential Employment Support Professionals
Step 6: Begin delivering services upon ISP approval and participant referral

5. REQUIRED DOCUMENTATION

Articles of Incorporation, EIN, and NPI

Medicaid provider number and waiver service approval

Employment Services P&P Manual including:

Intake assessments and employment goal documentation

Vocational support planning and documentation tools

Job coaching and progress tracking logs

Emergency and safety plans for worksite visits

Transportation and community-based risk protocols

Client rights, informed choice, and grievance policies

Staff training and supervision schedules

Billing and service delivery templates aligned with ISP goals

6. STAFFING REQUIREMENTS

Role: Employment Specialist / Job Coach
Requirements:

Experience working with individuals with disabilities

Completion of required WV CARES background check

CPR/First Aid, HIPAA, and abuse prevention training

Optional credentials (e.g., ACRE certification or CESP)

Role: Employment Program Supervisor / Coordinator
Responsibilities: Oversees program design, job placement strategies, and data reporting

All staff must complete:

Annual training in waiver documentation and service delivery

Community integration and workplace safety training

ISP alignment and progress documentation compliance

7. MEDICAID WAIVER PROGRAMS THAT COVER EMPLOYMENT SERVICES

I/DD Waiver – Employment Development Services, Supported Employment, and Job Coaching

CSEDW – May allow employment readiness and coaching for youth

TBIW – Can include supported employment on a case-by-case basis

State Plan Medicaid – May not cover employment directly but can support related services (e.g., transportation or behavioral therapy)

Note: Services must be linked to the participant’s plan and demonstrate alignment with community employment goals.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Readiness Planning
Timeline: 2–3 weeks

Phase: Medicaid & Waiver Enrollment Application
Timeline: 1–2 months

Phase: Staff Credentialing & Manual Development
Timeline: 30–45 days

Phase: Launch of Services
Timeline: Begins once authorization is received in ISP and participant referrals are secured

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

WV Division of Rehabilitation Services (WVDRS)
Website: https://drs.wv.gov

Acentra Health (formerly Kepro)
Website: https://wv.acentra.com

WV Secretary of State – Business Registration
Website: https://sos.wv.gov

Gainwell Technologies – WV Medicaid Enrollment
Website: https://www.wvmmis.com

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA EMPLOYMENT SERVICES PROVIDER
WCG helps providers launch person-centered employment programs that support participants in achieving real job outcomes with full Medicaid compliance.

​

Scope of Work:

Medicaid waiver enrollment and service line selection

Employment Services Policy & Procedure Manual development

ISP-aligned documentation templates and coaching logs

Staff credentialing packets and ongoing training schedules

Transportation protocols and employer engagement tools

Billing setup and job placement documentation systems

ELECTRONIC MONITORING SERVICES PROVIDER IN WEST VIRGINIA
SUPPORTING INDEPENDENT LIVING THROUGH REMOTE SUPERVISION AND SAFETY TECHNOLOGY FOR INDIVIDUALS WITH DISABILITIES OR CHRONIC NEEDS

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Electronic Monitoring Services in West Virginia are designed to enhance the safety and autonomy of Medicaid waiver participants through the use of remote supervision and assistive technology. These services support individuals who can live independently with occasional oversight and are especially valuable for individuals with cognitive, developmental, or behavioral challenges.

This service is covered under the Intellectual/Developmental Disabilities (I/DD) Waiver, and in some cases, under the Traumatic Brain Injury Waiver (TBIW). Oversight is provided by the West Virginia Department of Health and Human Resources (WVDHHR) and the Bureau for Medical Services (BMS).

1. GOVERNING AGENCIES

Agency: West Virginia Department of Health and Human Resources (WVDHHR)
Role: Administers waiver programs and monitors service quality and participant rights.

Agency: Bureau for Medical Services (BMS)
Role: Regulates Medicaid reimbursement, approves provider applications, and oversees program implementation.

Agency: Acentra Health (formerly Kepro)
Role: Conducts participant assessments and approves services like Electronic Monitoring through the PCSP/ISP process.

2. ELECTRONIC MONITORING SERVICES OVERVIEW

Electronic Monitoring (EM) involves real-time oversight through technology, ensuring a participant’s safety without requiring constant in-person supervision. EM supports include:

In-home camera monitoring systems

Motion sensors and door alarms

Remote two-way communication devices

Fall detection and alert systems

Environmental sensors (e.g., stove usage, smoke detectors)

GPS tracking devices for individuals with elopement risks

Integration with a 24/7 monitoring center or designated natural support

All services must be approved in the participant’s Person-Centered Service Plan (PCSP) and must reduce the need for costlier in-person staffing.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the WV Secretary of State

Obtain an EIN and Type 2 NPI

Submit an Electronic Monitoring service provider application under the I/DD Waiver (via BMS)

Enroll in West Virginia Medicaid through Gainwell Technologies

Partner with or operate a 24/7 response center

Create a comprehensive Policy & Procedure Manual for EM services

Maintain general liability insurance, equipment warranties, and privacy safeguards

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your business and obtain EIN and NPI
Step 2: Apply to be an I/DD Waiver EM Provider through WVDHHR
Step 3: Complete Medicaid provider enrollment with Gainwell Technologies
Step 4: Submit Policy & Procedure Manual for review and approval
Step 5: Ensure technology solutions meet privacy, HIPAA, and security requirements
Step 6: Begin accepting referrals after service plan inclusion and approval

5. REQUIRED DOCUMENTATION

Business registration and tax ID

Medicaid provider approval and signed waiver contract

EM Policy & Procedure Manual, including:

System installation, training, and maintenance procedures

Monitoring response protocols and escalation steps

Client consent and informed choice documentation

Data security, video storage, and HIPAA compliance protocols

Notification system for caregivers or emergency contacts

Equipment testing and malfunction response process

Staff credentialing and privacy training

6. STAFFING REQUIREMENTS

Role: Monitoring Center Operator (may be in-house or subcontracted)
Requirements:

Available 24/7 for alert responses

Must log incidents, notify contacts, and escalate as needed

HIPAA trained and bound by client confidentiality laws

Role: Installation Technician / Support Specialist
Requirements:

Responsible for equipment setup and participant training

Must pass WV CARES background check

Trained in device operation, troubleshooting, and documentation

All staff must complete:

HIPAA, emergency response, and abuse prevention training

Documentation and reporting requirements

Annual reviews of system functionality and participant safety protocols

7. MEDICAID PROGRAMS THAT COVER ELECTRONIC MONITORING

I/DD Waiver – Covers EM for individuals who can live semi-independently with remote supervision

Traumatic Brain Injury Waiver (TBIW) – May approve EM on a case-by-case basis if outlined in the ISP

Aged and Disabled Waiver (ADW) – Does not typically include EM unless authorized through a separate safety or assistive technology service

All EM services must be included in the participant’s service plan and must be cost-effective compared to alternatives such as 1:1 staffing.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Medicaid Enrollment
Timeline: 2–4 weeks

Phase: Technology Setup & Policy Manual Completion
Timeline: 2–3 weeks

Phase: Provider Approval & Referral Onboarding
Timeline: 30–60 days

Phase: Launch of Services
Timeline: Begins once ISP/PCSP authorization is in place and equipment is installed

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

Acentra Health (formerly Kepro)
Website: https://wv.acentra.com

WV Secretary of State – Business Portal
Website: https://sos.wv.gov

Gainwell Technologies – Medicaid Enrollment
Website: https://www.wvmmis.com

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA ELECTRONIC MONITORING PROVIDER
WCG helps agencies launch compliant EM programs by providing full-service documentation, technology readiness, and Medicaid billing setup.

​

Scope of Work:

Medicaid enrollment and I/DD Waiver application support

EM Policy & Procedure Manual creation and review

Consent forms, incident logs, and notification templates

Equipment training protocols and HIPAA compliance tools

Backup and escalation workflows for monitoring response centers

Billing templates and Medicaid documentation guidance

BEHAVIOR SUPPORT SERVICES PROVIDER IN WEST VIRGINIA
DELIVERING FUNCTIONAL ASSESSMENTS, POSITIVE BEHAVIOR INTERVENTIONS, AND INDIVIDUALIZED STRATEGIES TO PROMOTE STABILITY, SAFETY, AND INDEPENDENCE

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Behavior Support Services in West Virginia are designed to help individuals with intellectual or developmental disabilities, behavioral health needs, or emotional challenges develop adaptive behaviors, manage triggers, and reduce harmful or disruptive actions. These services are an essential part of many Medicaid waiver programs and are delivered by qualified behavior professionals using person-centered strategies.

These supports are funded primarily under the Intellectual/Developmental Disabilities (I/DD) Waiver and the Children with Serious Emotional Disorder Waiver (CSEDW). Service authorizations are approved by Acentra Health (formerly Kepro) and must align with the Individualized Service Plan (ISP) or Person-Centered Service Plan (PCSP). Oversight is provided by the WV Department of Health and Human Resources (WVDHHR) and the Bureau for Medical Services (BMS).

1. GOVERNING AGENCIES

Agency: West Virginia Department of Health and Human Resources (WVDHHR)
Role: Oversees service guidelines and ensures provider quality under Medicaid waivers.

Agency: Bureau for Medical Services (BMS)
Role: Handles Medicaid billing, waiver compliance, and provider enrollment.

Agency: Acentra Health (formerly Kepro)
Role: Reviews behavior support requests, approves authorizations, and monitors service delivery.

Agency: WV Behavior Analyst Licensure Board
Role: Licenses Behavior Analysts and ensures ethical and professional compliance.

2. BEHAVIOR SUPPORT SERVICES OVERVIEW

Behavior Support Services provide professional consultation and direct intervention to individuals with challenging behaviors that interfere with daily functioning, relationships, safety, or community access. Services are based on Functional Behavior Assessments (FBA) and the development of Behavior Support Plans (BSPs).

Covered services include:

Functional Behavior Assessments (FBA)

Development and implementation of Behavior Support Plans (BSP)

Staff and caregiver training on behavior strategies

Crisis prevention and de-escalation support

Ongoing monitoring and plan revisions

Collaboration with interdisciplinary teams

Direct intervention (when allowed under plan)

All behavior interventions must be positive, non-aversive, and evidence-based, with a focus on increasing the person’s independence and quality of life.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the WV Secretary of State

Obtain a Federal EIN and Type 2 NPI

Apply as a Behavior Support Services provider through WVDHHR

Complete Medicaid provider enrollment through Gainwell Technologies

Employ or contract licensed professionals such as Board Certified Behavior Analysts (BCBAs) or Licensed Behavior Analysts (LBAs)

Submit a Behavior Support Services Policy & Procedure Manual

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your business and obtain EIN and NPI
Step 2: Apply to become a behavior services provider under the I/DD Waiver or CSEDW
Step 3: Enroll with WV Medicaid via Gainwell Technologies
Step 4: Submit therapist/clinician credentials and license verification
Step 5: Provide a Policy & Procedure Manual outlining behavior assessment and support protocols
Step 6: Receive ISP authorizations and begin services

5. REQUIRED DOCUMENTATION

Business registration and Medicaid provider agreement

BCBA/LBA licenses and certifications

Behavior Support Services P&P Manual including:

FBA procedures and plan development workflows

Consent forms for behavior interventions

Staff and caregiver training logs

Data collection and progress review tools

Behavior incident tracking and crisis debriefing templates

HIPAA, safety, and restraint policy (if applicable)

Collaboration forms for interdisciplinary planning

Billing documentation aligned with service authorization

6. STAFFING REQUIREMENTS

Role: Licensed Behavior Analyst (LBA) / BCBA
Requirements:

Licensed in WV

Certified by the Behavior Analyst Certification Board (BACB)

WV CARES background check

Trained in abuse prevention, HIPAA, and Medicaid documentation

Role: Behavior Support Technician (if allowed)
Requirements:

Works under supervision of BCBA or LBA

Trained in implementing behavior plans and documenting interventions

All staff must complete:

HIPAA, client rights, and behavioral ethics training

Positive Behavior Support and de-escalation techniques (e.g., MANDT, CPI)

Ongoing CEUs as required by licensure boards

7. MEDICAID WAIVERS THAT COVER BEHAVIOR SUPPORT SERVICES

I/DD Waiver – Covers both FBA and BSP development, along with caregiver and staff training

CSEDW – Allows behavior therapy and parent training for children with serious emotional disorders

TBIW – May approve behavior supports in limited cases based on need

State Plan Medicaid – May fund behavior health services under EPSDT for youth

Note: All behavior services must be authorized in the ISP, tied to specific behavior goals, and aligned with waiver regulations.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Provider Setup
Timeline: 2–3 weeks

Phase: Medicaid Enrollment & Licensing Documentation
Timeline: 1–2 months

Phase: Policy Manual & Staff Credentialing
Timeline: 30–45 days

Phase: Launch of Services
Timeline: Begins upon plan approval and participant authorization

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

WV Behavior Analyst Licensure Board
Website: https://behavioralhealth.wv.gov

Acentra Health (formerly Kepro)
Website: https://wv.acentra.com

WV Secretary of State – Business Registration
Website: https://sos.wv.gov

Gainwell Technologies – WV Medicaid Enrollment
Website: https://www.wvmmis.com

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA BEHAVIOR SUPPORT SERVICES PROVIDER
WCG helps new and existing providers launch Medicaid-compliant behavior support programs with strong documentation systems and ethical intervention models.

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Scope of Work:

Medicaid and waiver enrollment assistance

Behavior Support Services Policy & Procedure Manual development

FBA, BSP, and progress tracking templates

Staff credentialing and licensure tracking

Incident report tools and crisis response protocols

Billing tools and audit preparation forms

HOME MODIFICATION SERVICES PROVIDER IN WEST VIRGINIA
CREATING SAFE, ACCESSIBLE, AND INDIVIDUALIZED LIVING SPACES TO SUPPORT INDEPENDENCE AND QUALITY OF LIFE AT HOME

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Home Modification Services in West Virginia provide physical changes to a person’s home environment to promote safety, accessibility, and continued residence in a community-based setting. These modifications are often essential for individuals with mobility challenges, chronic health conditions, or developmental disabilities who receive long-term services under Medicaid waiver programs.

These services are typically authorized through the Intellectual/Developmental Disabilities (I/DD) Waiver, Aged and Disabled Waiver (ADW), or Traumatic Brain Injury Waiver (TBIW). Oversight is provided by the West Virginia Department of Health and Human Resources (WVDHHR) and the Bureau for Medical Services (BMS), with service plan approval facilitated by Acentra Health (formerly Kepro).

1. GOVERNING AGENCIES

Agency: West Virginia Department of Health and Human Resources (WVDHHR)
Role: Oversees waiver programs, monitors compliance, and determines eligibility.

Agency: Bureau for Medical Services (BMS)
Role: Administers Medicaid funding, claims, and provider enrollment.

Agency: Acentra Health (formerly Kepro)
Role: Reviews and authorizes home modifications through the participant’s Individualized Service Plan (ISP).

2. HOME MODIFICATION SERVICES OVERVIEW

Home Modification Services involve permanent or semi-permanent changes to a participant’s primary residence to increase safety, accessibility, and independence. Modifications must be directly related to the participant’s disability and approved through their service plan.

Examples of approved modifications:

Wheelchair ramps and stair lifts

Widened doorways and hallways

Roll-in showers or accessible bathtubs

Grab bars and handrails

Lowered countertops and sinks

Bathroom and kitchen adaptations

Voice-activated or remote-controlled environmental controls

Specialized lighting, alarms, or alerts for individuals with sensory impairments

Minor structural changes to accommodate durable medical equipment (DME)

All work must comply with local building codes, ADA guidelines, and Medicaid cost caps outlined in the waiver policy.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the WV Secretary of State

Obtain EIN and Type 2 NPI

Submit Medicaid provider application through Gainwell Technologies

Apply to become a waiver-approved Home Modification provider

Provide documentation of contractor licensing, insurance, and bonding

Submit a Home Modification Services Policy & Procedure Manual

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN and NPI
Step 2: Apply to WVDHHR or BMS as a waiver Home Modification provider
Step 3: Enroll with Medicaid via Gainwell Technologies
Step 4: Submit contractor credentials, licensing, and bonding information
Step 5: Provide a comprehensive Policy & Procedure Manual
Step 6: Begin receiving referrals after service authorization by Acentra Health

5. REQUIRED DOCUMENTATION

Business registration and contractor license

General liability insurance and bonding documentation

Medicaid enrollment confirmation and provider number

Home Modification Services P&P Manual including:

Project estimate and authorization workflows

ADA compliance and accessibility standards

Construction timelines and worksite safety protocols

Final inspection and client sign-off forms

Warranty and post-installation repair procedures

Grievance and complaint handling policy

Documentation templates for before/after photos, invoices, and service logs

6. STAFFING REQUIREMENTS

Role: Licensed Contractor / Construction Specialist
Requirements:

WV contractor license

Familiarity with ADA, accessibility, and waiver requirements

WV CARES background check (if entering participant homes)

Liability and worker’s comp insurance coverage

Role: Project Manager / Estimator
Responsibilities:

Coordinates site assessments, obtains materials, and ensures waiver compliance

Role: Administrative Support (optional)
Responsibilities:

Tracks authorizations, billing, and final approvals

All staff must complete:

HIPAA and confidentiality training

Training on Medicaid waiver expectations and communication with case managers

Worksite safety and incident reporting protocols

7. MEDICAID WAIVERS THAT COVER HOME MODIFICATIONS

I/DD Waiver – For individuals with developmental disabilities needing structural home changes

ADW (Aged and Disabled Waiver) – For seniors or adults with physical disabilities

TBIW (Traumatic Brain Injury Waiver) – For individuals needing home adaptation post-injury

CSEDW (Children with Serious Emotional Disorders Waiver) – On a case-by-case basis for safety modifications

Note: All modifications must be pre-approved, clearly documented in the ISP, and supported by an occupational therapist or physician recommendation when required.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Licensing
Timeline: 2–4 weeks

Phase: Medicaid and Waiver Enrollment Application
Timeline: 1–2 months

Phase: Manual Development & Documentation Submission
Timeline: 30–45 days

Phase: Service Launch
Timeline: Begins after authorization and referral from case manager or service coordinator

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

Acentra Health (formerly Kepro)
Website: https://wv.acentra.com

WV Secretary of State – Business Registration
Website: https://sos.wv.gov

WV Division of Labor – Contractor Licensing
Website: https://labor.wv.gov

Gainwell Technologies – WV Medicaid Enrollment
Website: https://www.wvmmis.com

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA HOME MODIFICATION PROVIDER
WCG helps contractors and home adaptation providers launch compliant Medicaid waiver services with the right paperwork, standards, and reimbursement tools.

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Scope of Work:

Waiver service line selection and Medicaid enrollment

Home Modification Services P&P Manual development

Estimate and invoicing templates

Authorization tracking and billing forms

Before/after photo logs and inspection reports

Complaint resolution and documentation systems

SPECIALIZED THERAPY SERVICES PROVIDER IN WEST VIRGINIA
DELIVERING CUSTOMIZED OCCUPATIONAL, PHYSICAL, SPEECH, AND BEHAVIORAL THERAPIES TO SUPPORT INDIVIDUAL GROWTH AND FUNCTIONAL INDEPENDENCE

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Specialized Therapy Services in West Virginia are designed to help individuals with disabilities, developmental delays, or chronic conditions improve mobility, communication, sensory processing, behavioral regulation, and daily living skills. These therapies are delivered as part of a participant’s Individualized Service Plan (ISP) under Medicaid waiver programs or through Medicaid State Plan services.

Specialized therapies are often included in the Intellectual/Developmental Disabilities (I/DD) Waiver, Children with Serious Emotional Disorder Waiver (CSEDW), and Traumatic Brain Injury Waiver (TBIW). Oversight is provided by the West Virginia Department of Health and Human Resources (WVDHHR) and the Bureau for Medical Services (BMS).

1. GOVERNING AGENCIES

Agency: West Virginia Department of Health and Human Resources (WVDHHR)
Role: Manages waiver programs and monitors service quality.

Agency: Bureau for Medical Services (BMS)
Role: Handles Medicaid billing, provider enrollment, and documentation review.

Agency: Acentra Health (formerly Kepro)
Role: Reviews therapy needs during assessments and authorizes ISP service plans.

Agency: West Virginia Board of Examiners (PT, OT, SLP, etc.)
Role: Licenses therapists and enforces professional standards.

2. SPECIALIZED THERAPY SERVICES OVERVIEW

Specialized Therapy Services include individualized treatment to help participants reach developmental or functional goals. These services must be prescribed or recommended in the ISP and documented by a licensed professional.

Therapies may include:

Occupational Therapy (OT): Fine motor skills, sensory integration, ADLs

Physical Therapy (PT): Gross motor function, strength, balance, mobility aids

Speech-Language Pathology (SLP): Communication skills, feeding, swallowing

Behavioral Therapy / Applied Behavior Analysis (ABA): Behavior modification, social-emotional development

Recreational or Music Therapy (as allowed by waiver)

Feeding therapy or sensory therapy (if clinically justified)

Services can be delivered in-home, in clinic, or within day/residential programs, and must be tied to measurable ISP goals.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the WV Secretary of State

Obtain an EIN and Type 2 NPI

Apply to become a waiver or Medicaid-enrolled therapy provider

Ensure all clinicians hold active West Virginia licensure in their discipline

Submit a Specialized Therapy Services Policy & Procedure Manual

If offering services in a facility, meet any OHFLAC licensure or safety requirements

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN and NPI
Step 2: Apply through BMS to become a waiver therapy services provider
Step 3: Complete Medicaid provider enrollment through Gainwell Technologies
Step 4: Submit Policy & Procedure Manual and documentation of therapist credentials
Step 5: Develop documentation tools aligned with ISP goals and billing requirements
Step 6: Begin providing services once participant authorization is secured

5. REQUIRED DOCUMENTATION

Business registration, Medicaid provider agreement

Therapist licenses and certification records

Specialized Therapy Services Policy & Procedure Manual including:

Intake and assessment processes

Therapy treatment plan development

Session documentation templates

Progress monitoring and goal adjustment

Safety, infection control, and equipment sanitization protocols

HIPAA and patient rights policies

Authorization and service tracking aligned with ISP goals

Discharge or transition documentation procedures

6. STAFFING REQUIREMENTS

Role: Licensed Therapist (OT, PT, SLP, LBA, etc.)
Requirements:

Active West Virginia license

CPR/First Aid certification

WV CARES background check

Trained in HIPAA, abuse prevention, and service-specific techniques

Role: Therapy Assistant (COTA, PTA, SLPA – if applicable)
Requirements:

Licensed or certified under WV board requirements

Must work under supervision of a licensed therapist

All clinical staff must complete:

Ongoing CEUs required by licensure board

Waiver-specific training on documentation and Medicaid billing

Emergency protocols and safety drills

7. MEDICAID PROGRAMS THAT COVER THERAPY SERVICES

I/DD Waiver – Covers habilitative therapies related to function, behavior, and independence

CSEDW – Authorizes emotional, behavioral, and speech therapy for youth

TBIW – May approve PT, OT, or speech therapy to address deficits caused by brain injury

State Plan Medicaid – May cover therapy when medically necessary and physician-ordered

All therapies must be linked to the participant’s service plan and authorized through Acentra Health or applicable utilization review.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Staffing Plan
Timeline: 2–4 weeks

Phase: Medicaid Waiver Enrollment & Policy Submission
Timeline: 1–2 months

Phase: Staff Credentialing & Clinical Documentation Setup
Timeline: 30–45 days

Phase: Launch of Services
Timeline: Begins after authorization of ISP goals and service approval

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

WV Board of Occupational Therapy
Website: https://www.wvbot.org

WV Board of Physical Therapy
Website: https://www.wvbopt.wv.gov

WV Board of Examiners for Speech-Language Pathology and Audiology
Website: https://wvspeechandaudiology.com

Acentra Health (formerly Kepro)
Website: https://wv.acentra.com

Gainwell Technologies – WV Medicaid Enrollment
Website: https://www.wvmmis.com

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA THERAPY SERVICES PROVIDER
WCG supports therapy agencies in launching Medicaid-compliant specialized therapy programs that meet clinical, billing, and ISP alignment standards.

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Scope of Work:

Medicaid and waiver enrollment support

Specialized Therapy P&P Manual development

Assessment templates, progress notes, and treatment logs

CEU tracking, supervision plans, and credentialing tools

HIPAA forms, consent documents, and safety protocols

Billing documentation aligned with therapy authorizations

COMMUNITY INTEGRATION SERVICES PROVIDER IN WEST VIRGINIA
EMPOWERING INDIVIDUALS TO ACCESS, PARTICIPATE IN, AND CONTRIBUTE TO COMMUNITY LIFE THROUGH PERSONALIZED SUPPORTS AND SOCIAL ENGAGEMENT

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Community Integration Services in West Virginia are designed to help individuals with disabilities, mental health challenges, or functional impairments become active participants in their communities. These services focus on reducing isolation, building life skills, and promoting inclusion through tailored supports that align with the participant’s Individualized Service Plan (ISP) or Person-Centered Service Plan (PCSP).

These services are authorized under waiver programs like the Intellectual/Developmental Disabilities (I/DD) Waiver, Traumatic Brain Injury Waiver (TBIW), and Children with Serious Emotional Disorder Waiver (CSEDW). Oversight is provided by the West Virginia Department of Health and Human Resources (WVDHHR) and the Bureau for Medical Services (BMS), with service approvals managed by Acentra Health (formerly Kepro).

1. GOVERNING AGENCIES

Agency: WV Department of Health and Human Resources (WVDHHR)
Role: Oversees waiver service implementation and participant eligibility.

Agency: Bureau for Medical Services (BMS)
Role: Administers Medicaid funding, sets service definitions, and handles provider enrollment.

Agency: Acentra Health (formerly Kepro)
Role: Approves Community Integration services based on assessed needs and ISP goals.

2. COMMUNITY INTEGRATION SERVICES OVERVIEW

Community Integration Services provide structured support in community settings to help individuals develop meaningful relationships, access public resources, and engage in personal interests.

Service activities may include:

Support with navigating public transportation, libraries, or recreational spaces

Attending classes, support groups, or religious services

Volunteering or exploring pre-vocational activities

Participating in community-based health, wellness, or arts programs

Peer socialization and interpersonal skill-building

Promoting safety awareness and independence in public settings

Supporting cultural participation and civic engagement

Services are non-clinical, must occur outside of the home or residential facility, and should be integrated with individuals without disabilities whenever possible.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your organization with the WV Secretary of State

Obtain an EIN and Type 2 NPI

Apply as a Community Integration provider under eligible Medicaid waivers

Enroll with Gainwell Technologies as a Medicaid provider

Develop a Community Integration Services Policy & Procedure Manual

Hire or train Community Support Staff or Direct Support Professionals (DSPs)

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Complete business registration and obtain NPI/EIN
Step 2: Apply to become a Community Integration service provider with BMS
Step 3: Complete Medicaid enrollment via Gainwell Technologies
Step 4: Submit staff credentialing documents and P&P Manual
Step 5: Pass any site review or readiness checks
Step 6: Begin receiving authorizations and referrals upon ISP approval

5. REQUIRED DOCUMENTATION

Business registration, Medicaid provider contract, and waiver approval

Community Integration Services P&P Manual including:

Service goals, supervision, and progress tracking

Daily activity logs and community safety protocols

Consent forms for off-site activities

Emergency contact and incident reporting systems

Staff training and credentialing records

Transportation risk management policies

HIPAA and participant rights forms

Billing documentation aligned with ISP goals

6. STAFFING REQUIREMENTS

Role: Community Support Worker / Direct Support Professional (DSP)
Requirements:

WV CARES background check

CPR/First Aid certification

Training in abuse prevention, HIPAA, and person-centered planning

Role: Community Integration Coordinator (Optional)
Responsibilities:

Coordinates activity schedules, community partnerships, and progress monitoring

All staff must complete:

Waiver service documentation and billing training

Cultural competence and disability inclusion training

Transportation safety and community risk management orientation

7. MEDICAID WAIVERS THAT COVER COMMUNITY INTEGRATION

I/DD Waiver – Includes Community Integration to support inclusive living and reduce isolation

CSEDW – Authorizes youth-focused activities for emotional and behavioral support

TBIW – Allows services that promote community reintegration post-injury

ADW (Aged and Disabled Waiver) – May include community engagement support in limited cases

All services must be ISP-approved and delivered in a way that promotes independence and dignity.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Staff Planning
Timeline: 2–3 weeks

Phase: Medicaid Enrollment & Waiver Application
Timeline: 4–6 weeks

Phase: Manual Development & Readiness Review
Timeline: 30–45 days

Phase: Service Launch
Timeline: Begins after ISP authorization and participant matching

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

Acentra Health (formerly Kepro)
Website: https://wv.acentra.com

WV Secretary of State – Business Services
Website: https://sos.wv.gov

Gainwell Technologies – WV Medicaid Enrollment
Website: https://www.wvmmis.com

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA COMMUNITY INTEGRATION PROVIDER
WCG supports new and existing agencies in launching inclusive, compliant Community Integration programs that expand opportunities for people with disabilities across West Virginia.

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Scope of Work:

Medicaid and waiver service enrollment

Community Integration P&P Manual creation

ISP-aligned daily logs and progress tracking tools

Staff onboarding and training templates

Consent and risk management forms

Billing documentation and audit preparation

INDIVIDUAL AND FAMILY SUPPORT SERVICES PROVIDER IN WEST VIRGINIA
EMPOWERING FAMILIES TO THRIVE BY PROVIDING TRAINING, COUNSELING, AND IN-HOME SUPPORTS THAT STRENGTHEN CAREGIVER CAPACITY AND FAMILY STABILITY

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Individual and Family Support Services in West Virginia are designed to support caregivers, parents, guardians, and other family members of individuals receiving waiver services. These services focus on education, emotional support, skill-building, and respite, enabling families to sustain their caregiving role while promoting their own well-being and stability.

These supports are authorized under Medicaid waivers including the Children with Serious Emotional Disorder Waiver (CSEDW), Intellectual/Developmental Disabilities (I/DD) Waiver, and Traumatic Brain Injury Waiver (TBIW). The services are person- and family-centered and must be tied to the participant’s Individualized Service Plan (ISP).

1. GOVERNING AGENCIES

Agency: WV Department of Health and Human Resources (WVDHHR)
Role: Administers Medicaid waivers and ensures provider compliance with HCBS rules.

Agency: Bureau for Medical Services (BMS)
Role: Oversees Medicaid billing, provider enrollment, and waiver policy compliance.

Agency: Acentra Health (formerly Kepro)
Role: Approves service authorizations based on individual and family needs outlined in the ISP.

2. FAMILY-FOCUSED SERVICES OVERVIEW

Family Support Services aim to reduce caregiver burnout, improve family functioning, and provide education around the individual’s diagnosis, behavior, and daily needs. Services must be evidence-based and promote self-determination, family empowerment, and long-term care planning.

Covered services may include:

Family and Caregiver Training on conditions, medication management, or behavior support

Counseling Services for caregivers or families

Peer Mentorship or Support Groups facilitated by professionals

Crisis Planning and Emotional Support

Navigation of Community Resources and Benefits

Family Integration Activities tied to ISP goals

In-Home Family Support to improve daily routines, care techniques, and communication

All services must be documented, delivered according to Medicaid rules, and directly support the participant’s goals and outcomes.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register with the WV Secretary of State

Obtain a Federal EIN and Type 2 NPI

Apply to become a Medicaid waiver provider through BMS

Submit a Policy & Procedure Manual for Individual & Family Services

Hire or contract qualified professionals (counselors, family trainers, peer specialists)

Complete enrollment via Gainwell Technologies

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your business and secure EIN/NPI
Step 2: Apply to become a Family Support provider with the appropriate waiver authority
Step 3: Complete Medicaid provider enrollment via Gainwell Technologies
Step 4: Submit Policy & Procedure Manual and staff credentials
Step 5: Complete any site or compliance reviews
Step 6: Begin services upon ISP authorization and family referral

5. REQUIRED DOCUMENTATION

Business registration, waiver service approval, and Medicaid provider number

Family-Focused Services P&P Manual including:

Consent and confidentiality forms for caregivers

Training outlines and educational materials

Crisis planning and de-escalation protocols

Documentation of family participation and satisfaction

Grievance procedures for caregivers

Cultural competence and trauma-informed care policies

Billing documentation and service verification tools

6. STAFFING REQUIREMENTS

Role: Family Trainer / Counselor / Peer Specialist
Requirements:

Clinical licensure (LPC, LCSW) for counseling services

Relevant certification or experience for peer support and family education

WV CARES background check

Training in HIPAA, trauma-informed care, and family-centered planning

All staff must complete:

Documentation and service note training

Person- and family-centered practice principles

Crisis management and reporting

Cultural and linguistic competence education

7. MEDICAID WAIVERS THAT COVER FAMILY SUPPORT SERVICES

CSEDW – Family training, counseling, and crisis support for caregivers of children with serious emotional disorders

I/DD Waiver – Peer support, family integration, and caregiver skill-building

TBIW – Family supports tailored to injury-related cognitive and behavior changes

EPSDT (State Plan) – May support some counseling services for minors

All services must be ISP-authorized, family-directed, and promote long-term family stability and participant success in the community.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Documentation Prep
Timeline: 2–4 weeks

Phase: Medicaid Enrollment & Waiver Application
Timeline: 4–6 weeks

Phase: Staff Hiring & Manual Submission
Timeline: 30–45 days

Phase: Launch of Services
Timeline: Begins after ISP approval and participant referral

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

Acentra Health (formerly Kepro)
Website: https://wv.acentra.com

WV Secretary of State – Business Services
Website: https://sos.wv.gov

Gainwell Technologies – Medicaid Enrollment Portal
Website: https://www.wvmmis.com

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA FAMILY SUPPORT PROVIDER
WCG helps providers launch compassionate, family-centered services that build resilience and capacity among caregivers while meeting Medicaid documentation and service standards.

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Scope of Work:

Medicaid and waiver enrollment support

Family Support Services P&P Manual development

Staff training materials and caregiver feedback tools

Consent, confidentiality, and cultural competence forms

Billing documentation and ISP-linked service notes

Templates for family workshops, logs, and evaluations

CASE MANAGEMENT SERVICES PROVIDER IN WEST VIRGINIA
COORDINATING INDIVIDUALIZED SUPPORT PLANS TO HELP WAIVER PARTICIPANTS LIVE SAFELY, INDEPENDENTLY, AND WITH DIGNITY

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Case Management Services in West Virginia ensure comprehensive planning, coordination, advocacy, and oversight of services for individuals enrolled in Medicaid waiver programs, particularly the Aged and Disabled Waiver (ADW) and the Intellectual/Developmental Disabilities (I/DD) Waiver. Case managers play a critical role in helping participants access the right supports while ensuring ongoing compliance with Medicaid policies.

Oversight is provided by the West Virginia Department of Health and Human Resources (WVDHHR) and the Bureau for Medical Services (BMS). Case managers must follow strict state guidelines and develop Person-Centered Service Plans (PCSPs) tailored to each individual’s needs and goals.

1. GOVERNING AGENCIES

Agency: West Virginia Department of Health and Human Resources (WVDHHR)
Role: Administers and monitors waiver programs; regulates case management provider participation and performance.

Agency: Bureau for Medical Services (BMS)
Role: Operates the state’s Medicaid program and authorizes case management billing and provider enrollment.

Agency: Acentra Health (formerly Kepro)
Role: Conducts assessments, level-of-care determinations, and utilization reviews for waiver participants.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case managers ensure participants receive the right services, are making progress toward goals, and are living in the least restrictive environment. Duties include:

Initial and ongoing participant needs assessments

Development and review of Person-Centered Service Plans (PCSPs)

Coordination of medical, behavioral, and long-term support services

Advocacy and resource navigation

Monitoring service effectiveness and satisfaction

Crisis prevention and resolution

Compliance documentation and reporting

Case managers must ensure all services are Medicaid-eligible, goal-directed, and aligned with the participant’s preferences and capabilities.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the WV Secretary of State

Obtain a Federal EIN and Type 2 NPI

Complete Medicaid provider enrollment through Gainwell Technologies

Submit a Case Management Agency application to WVDHHR

Employ qualified Case Managers who meet education and experience criteria

Maintain general liability, fidelity, and professional insurance

Develop a Case Management Policy & Procedure Manual compliant with BMS and waiver requirements

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your business and obtain EIN and NPI
Step 2: Submit Case Management application to WVDHHR
Step 3: Complete Medicaid enrollment via Gainwell Technologies
Step 4: Hire/contract qualified case managers and designate a program administrator
Step 5: Finalize and submit Policy & Procedure Manual for approval
Step 6: Complete readiness review and begin accepting referrals

5. REQUIRED DOCUMENTATION

Business registration and tax ID

Medicaid Provider contract via Gainwell

Case Management Agency agreement with WVDHHR

Case Management Policy & Procedure Manual, including:

PCSP development and monitoring process

Documentation standards and timelines

HIPAA and confidentiality protocols

Participant rights and grievance procedures

Incident reporting and quality assurance

Conflict of interest and choice of provider policies

Staff training, supervision, and continuing education logs

6. STAFFING REQUIREMENTS

Role: Case Manager
Requirements:

Bachelor’s degree in a human services field (e.g., social work, psychology, nursing)

At least one year of experience with the waiver population

Completion of required WVDHHR and Acentra training

Ability to write PCSPs, track goals, and coordinate multidisciplinary services

Role: Program Administrator / Supervisor
Responsibilities: Ensures service delivery, documentation compliance, staff supervision

All staff must complete:

Background checks via WV CARES

HIPAA, participant rights, and abuse prevention training

Annual performance and documentation evaluations

7. MEDICAID PROGRAMS THAT INCLUDE CASE MANAGEMENT

Aged and Disabled Waiver (ADW) – For individuals 18+ with chronic conditions

Intellectual/Developmental Disabilities (I/DD) Waiver – For individuals with ID/DD and support needs

Traumatic Brain Injury Waiver (TBIW) – May include service coordination

Personal Options participants – Case managers coordinate participant-directed services

State Plan Targeted Case Management – For specific at-risk populations (varies by scope)

8. TIMELINE TO LAUNCH

Phase: Business Formation & Application Submission
Timeline: 2–4 weeks

Phase: Medicaid Enrollment & Staffing Compliance
Timeline: 1–2 months

Phase: P&P Manual Development & Readiness Approval
Timeline: 4–6 weeks

Phase: Launch of Services
Timeline: Begins once initial referrals are accepted and PCSPs developed

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

Acentra Health (formerly Kepro)
Website: https://wv.acentra.com

WV Secretary of State Business Portal
Website: https://sos.wv.gov

Gainwell Technologies – Medicaid Enrollment
Website: https://www.wvmmis.com

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA CASE MANAGEMENT AGENCY
WCG supports new providers with launching fully compliant case management programs that meet West Virginia’s waiver regulations and Medicaid documentation standards.

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Scope of Work:

Medicaid enrollment and BMS application guidance

Case Management Policy & Procedure Manual aligned with WV requirements

PCSP templates and quarterly monitoring tools

Staff hiring, supervision logs, and training plans

HIPAA, choice of provider, and incident reporting forms

Client intake, reassessment, and grievance documentation

NON-MEDICAL TRANSPORTATION SERVICES PROVIDER IN WEST VIRGINIA
ENABLING ACCESS TO COMMUNITY, WORK, AND SUPPORT SERVICES FOR MEDICAID WAIVER PARTICIPANTS THROUGH SAFE, DEPENDABLE TRANSPORTATION

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Non-Medical Transportation (NMT) Services in West Virginia provide transportation for individuals enrolled in Medicaid Home and Community-Based Services (HCBS) waivers to access community activities, day programs, employment, medical appointments, and other essential services outlined in their Person-Centered Service Plan (PCSP). Unlike Non-Emergency Medical Transportation (NEMT), NMT is not limited to medical appointments and is focused on promoting independence and full community participation.

NMT is covered under the Aged and Disabled Waiver (ADW), Intellectual/Developmental Disabilities (I/DD) Waiver, and other Medicaid waiver programs. Oversight is provided by the West Virginia Department of Health and Human Resources (WVDHHR) and the Bureau for Medical Services (BMS).

1. GOVERNING AGENCIES

Agency: West Virginia Department of Health and Human Resources (WVDHHR)
Role: Administers Medicaid waiver programs and regulates provider participation and service delivery.

Agency: Bureau for Medical Services (BMS)
Role: Manages Medicaid funding and oversees NMT reimbursement, provider enrollment, and policy enforcement.

Agency: Acentra Health (formerly Kepro)
Role: Performs functional assessments, utilization reviews, and prior authorizations for Medicaid waiver participants.

2. NON-MEDICAL TRANSPORTATION SERVICES OVERVIEW

NMT services assist participants in accessing necessary daily activities that support independence and quality of life. Approved transportation destinations may include:

Day habilitation or employment sites

Community events and recreational activities

Grocery shopping, banking, or pharmacy visits

Adult day programs and support centers

Other destinations outlined in the participant’s PCSP

Note: All trips must be pre-approved and authorized in the participant's service plan and are billed per trip or mile.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the WV Secretary of State

Obtain an EIN and Type 2 NPI

Apply to become a Medicaid Waiver Transportation Provider through BMS

Secure automobile liability insurance and maintain vehicle inspections

Ensure driver background checks, valid licenses, and clean driving records

Submit a Transportation Services Policy & Procedure Manual

Comply with ADA accessibility requirements (as applicable to passengers)

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI
Step 2: Submit NMT Provider application to BMS or through waiver-specific program (e.g., I/DD or ADW)
Step 3: Complete Medicaid enrollment via Gainwell Technologies
Step 4: Provide documentation of vehicles, insurance, and driver credentials
Step 5: Submit Policy & Procedure Manual for review and approval
Step 6: Begin accepting trip requests from case managers or support coordinators

5. REQUIRED DOCUMENTATION

WV business registration and tax ID

BMS or waiver-specific provider agreement

Medicaid provider number (via Gainwell Technologies)

Policy & Procedure Manual including:

Daily vehicle safety checklists

Emergency and incident response procedures

Transportation scheduling and trip log procedures

HIPAA confidentiality and passenger safety policies

Staff hiring, training, and credential tracking

Vehicle maintenance, registration, and insurance documentation

ADA accommodation protocols (if applicable)

6. STAFFING REQUIREMENTS

Role: Transportation Driver / Aide
Requirements:

Valid WV driver’s license

Clean driving record and background check (WV CARES)

CPR/First Aid certification preferred

Trained in transporting individuals with disabilities and HIPAA confidentiality

Optional Role: Dispatcher / Scheduler
Responsibilities: Manages trip requests, logs, and routing

All staff must complete:

Emergency preparedness and passenger safety training

HIPAA and abuse prevention training

Annual reviews and safety refreshers

Defensive driving training (recommended)

7. MEDICAID PROGRAMS THAT COVER NMT

Aged and Disabled Waiver (ADW) – Authorizes non-medical rides for community integration

I/DD Waiver – Allows for waiver-covered transportation to habilitation and employment activities

Personal Options Program – May include mileage reimbursement under participant-directed services

Traumatic Brain Injury Waiver (TBIW) – Based on PCSP inclusion

State Plan Services – Does not include NMT (only NEMT via brokers like MTM)

All services must be included in the participant’s approved service plan and authorized through the appropriate waiver program.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Credentialing
Timeline: 2–4 weeks

Phase: Medicaid Enrollment & P&P Manual Submission
Timeline: 1–2 months

Phase: Driver Background Checks & Vehicle Compliance
Timeline: 30–45 days

Phase: Launch of Services
Timeline: Begins upon approval and inclusion in PCSP

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

WV Secretary of State – Business Registration
Website: https://sos.wv.gov

Medicaid Enrollment – Gainwell Technologies
Website: https://www.wvmmis.com

Acentra Health (formerly Kepro)
Website: https://wv.acentra.com

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA NMT PROVIDER
WCG guides new agencies through launching Non-Medical Transportation services that meet all state and waiver-specific requirements, ensuring rapid enrollment and operational readiness.

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Scope of Work:

Medicaid enrollment and waiver program contracting

Transportation P&P Manual tailored to WV regulations

Trip log templates and daily vehicle checklists

Staff credentialing and background check workflows

Safety training resources and emergency procedures

HIPAA, abuse prevention, and passenger care documentation

HOME HEALTH SERVICES PROVIDER IN WEST VIRGINIA
DELIVERING SKILLED NURSING AND THERAPEUTIC CARE IN THE COMFORT OF HOME TO PROMOTE HEALING, STABILITY, AND INDEPENDENCE

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Home Health Services in West Virginia provide intermittent skilled nursing, therapy, and health monitoring to individuals who are recovering from illness, managing chronic conditions, or need support to prevent institutionalization. These services must be medically necessary and provided under a physician-directed Plan of Care (POC).

Home Health is covered under West Virginia’s State Medicaid Plan and may also be approved under waiver programs such as the Aged and Disabled Waiver (ADW) and Children with Serious Emotional Disorder Waiver (CSEDW) when skilled services are part of the individual's care plan.

Oversight is provided by the West Virginia Department of Health and Human Resources (WVDHHR), Bureau for Medical Services (BMS), and Office of Health Facility Licensure and Certification (OHFLAC).

1. GOVERNING AGENCIES

Agency: WV Bureau for Medical Services (BMS)
Role: Administers Medicaid enrollment, billing, and program guidelines for Home Health.

Agency: Office of Health Facility Licensure and Certification (OHFLAC)
Role: Issues and monitors Home Health Agency (HHA) licenses.

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Regulates Medicare and Medicaid Conditions of Participation (CoPs) for federally certified HHAs.

2. HOME HEALTH SERVICES OVERVIEW

Home Health services must be ordered by a physician and delivered by licensed professionals under a Plan of Care.

Covered services may include:

Skilled Nursing: Wound care, catheter management, injections, chronic disease management

Home Health Aide Services: Assistance with ADLs under nursing supervision

Physical Therapy (PT)

Occupational Therapy (OT)

Speech-Language Pathology (SLP)

Medical Social Work and Care Planning

Health Monitoring, Education, and Medication Management

Patient & Family Education

These services are typically short-term and goal-directed, aiming to help the individual regain function or avoid hospitalization.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your agency with the WV Secretary of State

Obtain a Federal EIN and Type 2 NPI

Apply for a Home Health Agency license from OHFLAC

Complete Medicare and/or Medicaid certification

Enroll as a provider via Gainwell Technologies (WVMMIS)

Maintain appropriate liability, malpractice, and workers’ comp insurance

Create a Home Health Services Policy & Procedure Manual

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI
Step 2: Submit HHA license application to OHFLAC
Step 3: Undergo site inspection and license approval
Step 4: Apply for Medicaid provider status via WVMMIS
Step 5: Pass CMS survey (if Medicare certification is desired)
Step 6: Hire and credential qualified staff
Step 7: Begin services upon receipt of referrals and physician orders

5. REQUIRED DOCUMENTATION

Articles of Incorporation, business registration, and EIN

OHFLAC-issued Home Health Agency license

CMS or WV Medicaid provider agreement

Policy & Procedure Manual including:

Nursing, therapy, and aide protocols

Plan of Care templates and physician order forms

Documentation procedures for skilled visits

HIPAA, infection control, and emergency preparedness policies

Incident reporting and medication management procedures

Staff credentialing and in-service training logs

Billing templates aligned with Medicaid documentation standards

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements: WV licensure, CPR certification, responsible for assessments, care plans, and supervision

Role: Licensed Practical Nurse (LPN)
Requirements: WV licensure; performs skilled nursing under RN direction

Role: Certified Home Health Aide (CHHA)
Requirements: State training completion, supervised by RN, assists with ADLs

Role: Therapists (PT, OT, SLP)
Requirements: Licensed in WV; care must be authorized and documented

Role: Medical Social Worker (MSW) (optional)
Requirements: Licensed; assists with discharge planning and community linkage

All staff must complete:

HIPAA, infection control, and abuse prevention training

Emergency response and safety training

Annual competency evaluations

7. MEDICAID PROGRAMS THAT COVER HOME HEALTH

State Plan Medicaid (EPSDT for children)

Aged and Disabled Waiver (ADW) – If skilled supports are needed

Children with Serious Emotional Disorder Waiver (CSEDW) – May include health monitoring

I/DD Waiver – Limited cases involving temporary skilled care or delegated nursing

Note: All services must be physician-prescribed and documented per CMS standards.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Licensing Prep
Timeline: 4–6 weeks

Phase: OHFLAC Licensing & CMS Readiness
Timeline: 2–4 months

Phase: Medicaid Enrollment & Staff Credentialing
Timeline: 45–60 days

Phase: Launch of Services
Timeline: Begins after certification and referral authorization

9. CONTACT INFORMATION

WV Office of Health Facility Licensure and Certification (OHFLAC)
Website: https://ohflac.wvdhhr.org

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov

Gainwell Technologies – Medicaid Enrollment Portal
Website: https://www.wvmmis.com

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA HOME HEALTH PROVIDER
WCG helps agencies launch compliant Home Health programs by providing licensing support, CMS readiness tools, and full clinical documentation systems.

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Scope of Work:

OHFLAC and Medicaid enrollment support

Home Health P&P Manual compliant with CMS

Staff credentialing tools and supervision logs

Plan of Care and physician order templates

Infection control and incident reporting systems

Skilled visit documentation and billing forms

MEAL & NUTRITION SERVICES PROVIDER IN WEST VIRGINIA
SUPPORTING HEALTH, INDEPENDENCE, AND WELL-BEING THROUGH NUTRITIOUS MEALS AND DIETARY EDUCATION IN COMMUNITY AND HOME SETTINGS

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Meal & Nutrition Services in West Virginia offer essential meal preparation, delivery, and nutritional counseling for individuals who are elderly, disabled, or medically fragile and unable to consistently prepare or access healthy meals on their own. These services promote health stability, reduce hospitalizations, and support community living.

Meal services may be authorized through West Virginia’s Aged and Disabled Waiver (ADW), Intellectual/Developmental Disabilities (I/DD) Waiver, and Children with Serious Emotional Disorder Waiver (CSEDW). Oversight is provided by the WV Department of Health and Human Resources (WVDHHR) and Bureau for Medical Services (BMS), with service plan approvals handled by Acentra Health (formerly Kepro).

1. GOVERNING AGENCIES

Agency: West Virginia Department of Health and Human Resources (WVDHHR)
Role: Administers waiver programs and ensures provider compliance with service standards.

Agency: Bureau for Medical Services (BMS)
Role: Handles Medicaid billing, provider enrollment, and reimbursement guidelines.

Agency: Acentra Health (formerly Kepro)
Role: Reviews and authorizes nutrition-related services through the participant’s ISP or PCSP.

2. MEAL & NUTRITION SERVICES OVERVIEW

These services ensure that individuals receiving HCBS supports have access to nutritious meals and guidance on managing health conditions through dietary planning.

Covered services may include:

Home-Delivered Meals (Hot or Frozen) based on medical need and care plan

Congregate Meals provided in adult day or community settings

Nutritional Counseling by a licensed dietitian for diabetes, weight loss, swallowing issues, etc.

Meal Planning and Shopping Assistance

Specialized Diet Preparation (pureed, low-sodium, gluten-free, diabetic-friendly)

Meals must meet dietary standards, be documented per Medicaid rules, and align with the individual’s assessed needs in their waiver service plan.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the WV Secretary of State

Obtain a Federal EIN and Type 2 NPI

Enroll with Gainwell Technologies as a Medicaid provider

If providing therapeutic diets or counseling, employ a licensed dietitian

Food handlers and delivery staff must comply with state food safety laws

Submit a Meal & Nutrition Services Policy & Procedure Manual

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN and NPI
Step 2: Apply to become a waiver Meal/Nutrition provider with BMS
Step 3: Enroll in WV Medicaid via Gainwell Technologies
Step 4: Submit credentials for dietitians, kitchen managers, and delivery staff
Step 5: Submit policy manual, sample menus, and nutritional tracking templates
Step 6: Begin services upon ISP authorization and care team referral

5. REQUIRED DOCUMENTATION

Business registration and NPI confirmation

WV Medicaid provider agreement

Meal & Nutrition Services P&P Manual including:

Menu planning templates and dietary tracking forms

Nutrition counseling documentation (for dietitians)

Delivery and storage protocols

Food safety and sanitation policies

Emergency meal delivery procedures

Consent forms, billing logs, and incident reporting templates

Staff training and credentialing logs

6. STAFFING REQUIREMENTS

Role: Nutritionist / Registered Dietitian (RD)
Requirements: WV licensure, HIPAA compliance, and experience with therapeutic diets

Role: Food Service Manager / Chef (optional)
Requirements: Food handler certification, experience with mass meal production

Role: Delivery Driver / Meal Transport Aide
Requirements: Background check, food safety training, valid driver's license

All staff must complete:

HIPAA and confidentiality training

Foodborne illness prevention and storage training

Client communication and cultural sensitivity training

7. MEDICAID WAIVERS THAT COVER MEAL & NUTRITION SERVICES

Aged and Disabled Waiver (ADW) – Provides home-delivered meals for those at risk of institutionalization

I/DD Waiver – May allow nutrition education and meal preparation assistance

CSEDW – For children with serious emotional disorders needing dietary guidance

State Plan Medicaid / EPSDT – May cover dietitian services for qualifying youth

Note: All services must be documented in the ISP and approved in advance by Acentra Health.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Program Design
Timeline: 2–3 weeks

Phase: Medicaid Enrollment & Staff Onboarding
Timeline: 1–2 months

Phase: Policy Manual Submission & Menu Prep
Timeline: 30–45 days

Phase: Service Launch
Timeline: Begins upon ISP authorization and care coordinator referral

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)
Website: https://dhhr.wv.gov/bms

Acentra Health (formerly Kepro)
Website: https://wv.acentra.com

WV Secretary of State – Business Registration
Website: https://sos.wv.gov

Gainwell Technologies – WV Medicaid Portal
Website: https://www.wvmmis.com

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA MEAL & NUTRITION SERVICES PROVIDER
WCG helps agencies build Medicaid-compliant nutrition programs that meet dietary standards, optimize delivery logistics, and align with state regulations.

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Scope of Work:

Medicaid enrollment and waiver provider registration

Meal & Nutrition Services P&P Manual development

Staff credentialing checklists and food handler tracking

Menu templates, nutrition logs, and billing forms

HIPAA and food safety documentation tools

Emergency and seasonal service planning kits