Bureau for Medical Services (BMS)
Operates the I/DD Waiver, signs provider agreements, and sets the requirements in Chapter 513 on top of the general provider participation requirements in Chapter 300.
304-356-4904Visit siteBack to provider resources
West Virginia provider enrollment
How to Become a Medicaid Waiver Provider in West Virginia
What West Virginia requires before you can deliver home and community-based waiver services, in the order the state actually requires it. Every claim links to the official page it came from.
Provider rules change often — confirm fees and deadlines against the linked sources before you rely on them.
Overview
Becoming a waiver provider in West Virginia
The Certificate of Need is the fact that decides whether West Virginia is viable for you. IDDW providers must receive CON approval from the West Virginia Health Care Authority, either through the full-length process or through Summary Review — and the CON is service-specific in a way that bites later: to contract with extended professionals for dietary therapy, occupational therapy, physical therapy, or speech therapy, those services must already be listed on your agency's CON. Get that scoped correctly the first time. Alongside it you need and must maintain a behavioral health license through OHFLAC, plus a valid provider agreement with the Bureau for Medical Services and a valid Medicaid enrollment agreement. One more requirement shapes your overheads: you must designate and staff at least one physical office inside West Virginia — a post office box or commercial mailbox will not suffice — and that office must meet ADA accessibility requirements, be readily identifiable to the public, keep a listed telephone number, and maintain a HIPAA-compliant email address for all staff.
Who certifies you
The agencies that decide
West Virginia Health Care Authority
Issues the Certificate of Need approval — through the full-length CON process or Summary Review — that IDDW providers must hold.
Visit siteOffice of Health Facility Licensure and Certification (OHFLAC)
Issues the behavioral health license IDDW providers must obtain and maintain, and mandates competency-based training standards.
Visit siteAcentra Health — Utilization Management Contractor (UMC)
Runs day-to-day operations and oversight of much of the program, including quarterly training sessions and routine conference calls providers must attend.
Visit siteBefore you apply
What has to be true first
A Certificate of Need, scoped to your services
Providers must receive CON approval from the West Virginia Health Care Authority through the full-length process or Summary Review. To contract with extended professionals for dietary, occupational, physical, or speech therapy, those services must be included on the agency's CON.
SourceA behavioral health license from OHFLAC
IDDW providers must obtain and maintain a behavioral health license through the DHHR Office of Health Facility Licensure and Certification.
SourceA physical West Virginia office that meets ADA
Providers must designate and staff at least one physical office within West Virginia — a P.O. box or commercial mailbox will not suffice. The office must meet ADA accessibility requirements including unobstructed passage, accessible entrances with curbs, sidewalks or ramps, restroom grab bars, and an accessible telephone.
SourceListed phone and HIPAA-compliant email
Each office must be readily identifiable to the public, maintain a primary telephone number listed with the business name and local address, and maintain an agency HIPAA-compliant email address for all staff to communicate with BMS and the UMC.
SourceEnrollment
How to enroll in West Virginia
Obtain CON approval scoped to your services, get the OHFLAC behavioral health license, meet Chapter 300 provider participation requirements, and sign the BMS provider agreement and Medicaid enrollment agreement.
- Scope and obtain the Certificate of Need
Through the full-length CON process or Summary Review. Include every therapy service you may want to contract for later — adding them afterward means going back to the CON.
Source - Obtain the OHFLAC behavioral health license
It must be obtained and then maintained; OHFLAC standards also govern the competency-based training your staff must document annually.
Source - Meet Chapter 300 provider participation requirements
Chapter 513's requirements sit on top of the general provider participation requirements in Chapter 300 of the provider manual, not instead of them.
Source - Sign the BMS provider agreement and Medicaid enrollment agreement
Providers must meet and maintain all BMS enrollment requirements, including a valid provider agreement on file signed by both the IDDW provider and BMS.
Source - Stand up the office and the communication channels
A staffed physical office in West Virginia meeting ADA requirements, a listed telephone number, and a HIPAA-compliant agency email address for all staff.
Source
Service types
What you can be approved to deliver
I/DD Waiver services
Intellectual and Developmental Disabilities Waiver (IDDW)
Therapy services must be on the CON
Dietary therapy, occupational therapy, physical therapy, and speech therapy must appear on the agency's Certificate of Need before it can contract with extended professionals to deliver them.
SourceExtended professional staff must meet the standards too
Providers employ or contract with extended professional agency staff who meet all applicable training and qualification requirements, and keep a record of training verification or recertification for each staff member.
SourceScreening
Background checks and staff eligibility
Approved criminal background checks are a hiring condition
Staff must have approved criminal background checks as defined in Chapter 513 section 513.2.1 before providing services.
SourceTraining
What your staff must complete
Training starts on day one of employment
Providers begin the mandatory IDDW Program training for all agency staff on the first day of employment and document all mandatory training on the Certificate of Training Form (WV-BMS-IDD-06).
SourceEmergency and competency training, annually
Training on emergency procedures such as crisis intervention and restraints is required on hire, and competency-based training must be documented initially and annually as mandated by OHFLAC and the IDDW manual. For everything except CPR and first aid — which expire per the card — annual means within the month the training expires.
SourceQuarterly sessions with the UMC
Providers must participate in quarterly training sessions and routine conference calls provided by the utilization management contractor.
SourceTimeline & cost
What this actually takes
The CON sets the runway
Certificate of Need approval — full-length or Summary Review — precedes everything else, and its scope determines which services you can ever contract for without returning to the Health Care Authority.
SourceA staffed in-state office is a fixed cost from the start
The physical office requirement is not satisfied by a mailbox, so budget for premises and staffing before revenue begins.
SourceAfter approval
Staying compliant
Documentation must be audit-ready
Services must be delivered and documented to regulatory and professional standards before a claim is submitted, and all required documentation must be maintained at the agency on behalf of the state and accessible for state and federal audits.
SourceDischarges need a viable transfer plan
A person may not be discharged unless a viable discharge or transfer plan effectively transfers all needed services to another provider and is agreed to by the person or their legal representative and the receiving provider.
SourceNo retaliation against complainants
Providers must ensure no person or staff member is discharged, discriminated against, or retaliated against for making a complaint, having one made on their behalf, or participating in an investigation.
SourceConfirm by phone
What the state does not publish
West Virginia does not publish these in a form we could verify, so we have not guessed at them. Ask directly — and if an answer here would help other providers, tell us and we will add it with its source.
- Does your service qualify for CON Summary Review rather than the full-length process, and how long does each take?
Ask: West Virginia Health Care Authority
- What does the OHFLAC behavioral health license application require, and what does it cost?
Ask: DHHR Office of Health Facility Licensure and Certification
- Is BMS currently enrolling new IDDW providers, and for which services and regions?
Ask: Bureau for Medical Services, 304-356-4904
- What is Acentra Health's role in your specific service authorizations, and what does its provider onboarding involve?
Ask: Acentra Health, the WV utilization management contractor
Key contacts
West Virginia provider contacts
Chapter 513 — Intellectual and Developmental Disabilities Waiver
The controlling manual: CON, OHFLAC licensure, office requirements, training, background checks, and documentation duties.
Visit siteI/DD Waiver Program
The program's own site.
304-356-4904Visit siteAcentra Health — WV I/DD
The utilization management contractor handling day-to-day program operations.
Visit siteFAQ
West Virginia provider questions
What is the biggest hurdle in West Virginia?
The Certificate of Need. IDDW providers must receive CON approval from the West Virginia Health Care Authority, and the CON must already list dietary, occupational, physical, or speech therapy for you to contract with extended professionals to provide them.
Can I run this from out of state?
No. You must designate and staff at least one physical office within West Virginia, and a post office box or commercial mailbox does not satisfy the requirement. The office must also meet ADA accessibility standards and keep a listed telephone number.
When does staff training start?
The first day of employment. Mandatory IDDW Program training begins then and is documented on the Certificate of Training Form WV-BMS-IDD-06, with emergency procedures training required on hire.
What does annual training mean here?
Within the month the training expires — that is the manual's definition for everything except CPR and first aid, which expire as indicated on the card.
Who oversees me day to day?
Acentra Health, as the Bureau for Medical Services' utilization management contractor, which handles much of the program's day-to-day operations and runs the quarterly training sessions and conference calls providers must attend.
Looking for the family-facing guide? Browse state waiver guides