1. Program Definition and Services

Community Integration Services under West Virginia's Medicaid waivers deliver professional, non-clinical, and person-centered support designed to help individuals with disabilities or mental health challenges actively engage in community life. These services focus on reducing isolation, cultivating peer relationships, and building real-world independence. Activities must occur in natural community settings alongside individuals without disabilities and are explicitly mapped to the participant's Individualized Service Plan (ISP) or Person-Centered Service Plan (PCSP). Authorized services include:

• Community Mobility Support
• Civic and Cultural Engagement
• Pre-Vocational & Volunteer Exploration
• Interpersonal and Safety Skills

2. Regulations

• West Virginia Department of Human Services (DoHS) / Bureau for Medical Services (BMS) Provider Manuals governing Home and Community-Based Services (HCBS) waivers (including the IDDW, CSEDW, and TBIW programmatic chapters)
• The CMS HCBS Settings Final Rule : Mandating that services are fully integrated into the community and support participant choice, privacy, and independence
• Health Insurance Portability and Accountability Act (HIPAA): Governing data security during mobile community operations and off-site service delivery

3. Licensing or Certification

Agencies must be approved as designated Medicaid Waiver Providers through the Bureau for Medical Services for specific non-clinical community support taxonomies. While the agency itself does not require an independent clinical facility license to operate an out-of-home integration program, it must maintain active provider enrollment status. 

4. Responsible State Agencies

• West Virginia Department of Human Services (DoHS): Established via the structural reorganization of the former WVDHHR, this department holds ultimate administrative authority over the state’s healthcare, family assistance, and waiver programs
• Bureau for Medical Services (BMS): Operating under DoHS as the single state Medicaid agency, BMS sets operational service definitions, controls provider enrollment, and issues reimbursement rates
• Acentra Health: The state's utilization review contractor responsible for assessing functional needs, approving individual service categories, and validating ISP integration goals
• Gainwell Technologies: Manages the West Virginia Medicaid Management Information System (MMIS) portal for provider enrollment execution and electronic claims processing

5. Application Process

• Register your legal corporate entity (LLC or Corporation) through the West Virginia Secretary of State's Office
• Apply for a Federal Employer Identification Number (EIN) and secure an organizational Type 2 National Provider Identifier (NPI)
• Draft a tailored Community Integration Services Policy & Procedure Manual aligned with West Virginia HCBS guidelines
• Submit the formal initial waiver provider application to the West Virginia Bureau for Medical Services (BMS)
• Upon BMS approval, complete Medicaid enrollment integration via the Gainwell Technologies MMIS portal to open billing lines

6. Required Documentation

• West Virginia business registration, corporate charter, and structural organizational charts
• Proof of operational commercial general liability, professional liability, and workers' compensation insurance coverage
• Community Integration Services Policy & Procedure Manual outlining internal protocols for community risk management, emergency incident handling, participant rights, vehicle/transportation safety, and medication administration (if applicable)
• Off-site activity consent forms, community safety assessments, individual goal sheets, and ISP-aligned daily activity log templates
• Staff compliance records including verified WV CARES background check clearances, CPR/First Aid certifications, and competency testing records

7. Timeline for Approval

The end-to-end framework to achieve business configuration, manual formulation, complete BMS evaluation, and active Gainwell system onboarding spans approximately 2 to 3 months.

8. Pre-Application Process

Before initiating the state portal application, the agency must be legally incorporated, possess an active EIN and Type 2 NPI, acquire its core commercial insurance policies, and build out its person-centered community safety protocols.

9. Pre-Application Training

Agency executives, designated program coordinators, and billing specialists must complete mandatory state-provided waiver orientation modules. These focus on electronic service authorization tracking via Acentra Health, person-centered planning frameworks, and Medicaid critical incident reporting rules.

10. Additional Notes

• All community integration activities must explicitly exclude purely residential, in-home, or clinic-confined care; services are strictly designated for natural public environments.
• Staff-to-participant ratios must strictly comply with the individualized tier allocations authorized by Acentra Health within the participant's approved service plan budget.

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.

To get started, click the link to request portal access