COMMUNITY INTEGRATION SERVICES PROVIDER IN WEST VIRGINIA

Fatumata Kaba
2 days ago
3 min read

EMPOWERING INDIVIDUALS TO ACCESS, PARTICIPATE IN, AND CONTRIBUTE TO COMMUNITY LIFE THROUGH PERSONALIZED SUPPORTS AND SOCIAL ENGAGEMENT

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).

https://video.wixstatic.com/video/dcc8e4_20da20bdd80249ba80eaf8698d9f5014/1080p/mp4/file.mp4

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

COMMUNITY INTEGRATION SERVICES PROVIDER IN WEST VIRGINIA

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.

Scope of Work: