1. Program Definition and Services

Non-Medical Transportation (NMT) Services under West Virginia’s Medicaid waivers provide safe, dependable transport to help participants access community life, employment, and essential services. Unlike Non-Emergency Medical Transportation (NEMT), which is restricted to clinical appointments, NMT explicitly enables social and community autonomy as outlined in the participant's Person-Centered Service Plan (PCSP). Authorized destinations and configurations include:

• Vocational and Competitive Employment Sites
• Community and Habilitation Hubs
• Waiver-Authorized Social Outings
• Service Models

2. Regulations

• West Virginia Department of Human Services (DoHS) Bureau for Medical Services (BMS) Policy Chapters
• The CMS Home and Community-Based Services (HCBS) Settings Final Rule 
• Americans with Disabilities Act (ADA)

3. Licensing or Certification

An agency must secure formal credentialing as an approved Medicaid Waiver Transportation Provider through BMS. While a Department of Transportation (DOT) commercial carrier permit is generally not required for standard, small-vehicle waiver operations, the agency must maintain specialized commercial fleet or comprehensive auto liability coverage.

4. Responsible State Agencies

• West Virginia Department of Human Services (DoHS): Serves as the cabinet-level administrative body that oversees all Medicaid HCBS waiver structures and health policies
• Bureau for Medical Services (BMS): Operates under DoHS to manage Medicaid funding, publish waiver policy amendments, and process provider enrollments
• Acentra Health: Acts as the utilization management partner that reviews functional tracking data, determines level-of-care requirements, and approves specific NMT trip allocations within the participant's PCSP
• Gainwell Technologies: Manages the West Virginia Medicaid Management Information System (MMIS) portal for active provider system mapping and electronic billing processing

5. Application Process

• Register your business legal entity (LLC or Corporation) with the West Virginia Secretary of State’s Office
• Obtain a Federal Employer Identification Number (EIN) and an organizational Type 2 National Provider Identifier (NPI) matching specialized transportation taxonomies
• Secure commercial vehicle insurance coverages that meet or exceed West Virginia Medicaid waiver minimum parameters
• Author a comprehensive Transportation Services Policy & Procedure Manual aligned with current BMS regulations
• Register and run all drivers through background checks via the WV CARES portal
• Submit your comprehensive provider enrollment packet to BMS and complete final digital integration within the Gainwell Technologies MMIS portal

6. Required Documentation

• West Virginia business registration, corporate documents, and matching EIN/Type 2 NPI credentials
• Valid vehicle registrations, state mechanical inspection certificates, and proof of comprehensive commercial auto liability insurance
• Transportation Services Policy Manual covering
• Verified driver qualification files including valid driver's licenses, clean DMV driving history records, and active WV CARES background check clearings
• Standardized odometer logs, trip routing verifications, and electronic service tracking tools

7. Timeline for Approval

The end-to-end period to register your corporate entity, complete full driver screening, secure specialized commercial auto lines, pass BMS manual reviews, and achieve active billing status in the Gainwell system tracks at 2 to 3 months.

8. Pre-Application Process

Prior to initiating state-level platform submissions, the enterprise must complete corporate formation, acquire its dedicated EIN and NPI numbers, secure its commercial fleet insurance policies, and establish vehicle safety validation procedures.

9. Pre-Application Training

Agency executives, dispatchers, and fleet supervisors must complete mandatory state provider orientation sessions. These emphasize correct utilization of Acentra authorization allocations, electronic claim logging, and critical incident reporting definitions.

10. Additional Notes

• Non-Medical Transportation claims must always correspond precisely with a validated PCSP activity; generic rides that do not directly support an authorized waiver goal cannot be billed to Medicaid.
• All transport logs must clearly record the origin, destination, exact odometer readings or fixed trip metrics, driver name, passenger identity, and the precise time of the service to pass post-payment audits.

Why Choose Waiver Consulting Group?

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

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