CASE MANAGEMENT SERVICES PROVIDER IN WEST VIRGINIA
- Fatumata Kaba
- Apr 14
- 3 min read
COORDINATING INDIVIDUALIZED SUPPORT PLANS TO HELP WAIVER PARTICIPANTS LIVE SAFELY, INDEPENDENTLY, AND WITH DIGNITY
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 are 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 in launching fully compliant case management programs that meet West Virginia’s waiver regulations and Medicaid documentation standards.
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
Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.
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