HOME HEALTH SERVICES PROVIDER IN WEST VIRGINIA

Fatumata Kaba
2 days ago
4 min read

DELIVERING SKILLED NURSING AND THERAPEUTIC CARE IN THE COMFORT OF HOME TO PROMOTE HEALING, STABILITY, AND INDEPENDENCE

Home Health Services in West Virginia provide intermittent skilled nursing, therapy, and health monitoring to individuals who are recovering from illness, managing chronic conditions, or need support to prevent institutionalization. These services must be medically necessary and provided under a physician-directed Plan of Care (POC).

Home Health is covered under West Virginia’s State Medicaid Plan and may also be approved under waiver programs such as the Aged and Disabled Waiver (ADW) and Children with Serious Emotional Disorder Waiver (CSEDW) when skilled services are part of the individual's care plan. Oversight is provided by the West Virginia Department of Health and Human Resources (WVDHHR), Bureau for Medical Services (BMS), and Office of Health Facility Licensure and Certification (OHFLAC).

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1. GOVERNING AGENCIES

Agency: WV Bureau for Medical Services (BMS)

Role: Administers Medicaid enrollment, billing, and program guidelines for Home Health.

Agency: Office of Health Facility Licensure and Certification (OHFLAC)

Role: Issues and monitors Home Health Agency (HHA) licenses.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Regulates Medicare and Medicaid Conditions of Participation (CoPs) for federally certified HHAs.

2. HOME HEALTH SERVICES OVERVIEW

Home Health services must be ordered by a physician and delivered by licensed professionals under a Plan of Care.

Covered services may include:

Skilled Nursing: Wound care, catheter management, injections, chronic disease management
Home Health Aide Services: Assistance with ADLs under nursing supervision
Physical Therapy (PT)
Occupational Therapy (OT)
Speech-Language Pathology (SLP)
Medical Social Work and Care Planning
Health Monitoring, Education, and Medication Management
Patient & Family Education

These services are typically short-term and goal-directed, aiming to help the individual regain function or avoid hospitalization.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your agency with the WV Secretary of State
Obtain a Federal EIN and Type 2 NPI
Apply for a Home Health Agency license from OHFLAC
Complete Medicare and/or Medicaid certification
Enroll as a provider via Gainwell Technologies (WVMMIS)
Maintain appropriate liability, malpractice, and workers’ comp insurance
Create a Home Health Services Policy & Procedure Manual

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI

Step 2: Submit HHA license application to OHFLAC

Step 3: Undergo site inspection and license approval

Step 4: Apply for Medicaid provider status via WVMMIS

Step 5: Pass CMS survey (if Medicare certification is desired)

Step 6: Hire and credential qualified staff

Step 7: Begin services upon receipt of referrals and physician orders

5. REQUIRED DOCUMENTATION

Articles of Incorporation, business registration, and EIN
OHFLAC-issued Home Health Agency license
CMS or WV Medicaid provider agreement
Policy & Procedure Manual including:
- Nursing, therapy, and aide protocols
- Plan of Care templates and physician order forms
- Documentation procedures for skilled visits
- HIPAA, infection control, and emergency preparedness policies
- Incident reporting and medication management procedures
- Staff credentialing and in-service training logs
- Billing templates aligned with Medicaid documentation standards

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements: WV licensure, CPR certification, responsible for assessments, care plans, and supervision

Role: Licensed Practical Nurse (LPN)

Requirements: WV licensure; performs skilled nursing under RN direction

Role: Certified Home Health Aide (CHHA)

Requirements: State training completion, supervised by RN, assists with ADLs

Role: Therapists (PT, OT, SLP)

Requirements: Licensed in WV; care must be authorized and documented

Role: Medical Social Worker (MSW) (optional)

Requirements: Licensed; assists with discharge planning and community linkage

All staff must complete:

HIPAA, infection control, and abuse prevention training
Emergency response and safety training
Annual competency evaluations

7. MEDICAID PROGRAMS THAT COVER HOME HEALTH

State Plan Medicaid (EPSDT for children)
Aged and Disabled Waiver (ADW) – If skilled supports are needed
Children with Serious Emotional Disorder Waiver (CSEDW) – May include health monitoring
I/DD Waiver – Limited cases involving temporary skilled care or delegated nursing

Note: All services must be physician-prescribed and documented per CMS standards.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Licensing Prep

Timeline: 4–6 weeks

Phase: OHFLAC Licensing & CMS Readiness

Timeline: 2–4 months

Phase: Medicaid Enrollment & Staff Credentialing

Timeline: 45–60 days

Phase: Launch of Services

Timeline: Begins after certification and referral authorization

9. CONTACT INFORMATION

WV Office of Health Facility Licensure and Certification (OHFLAC)

Website: https://ohflac.wvdhhr.org

WV Bureau for Medical Services (BMS)

Website: https://dhhr.wv.gov/bms

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

Gainwell Technologies – Medicaid Enrollment Portal

Website: https://www.wvmmis.com

HOME HEALTH SERVICES PROVIDER IN WEST VIRGINIA

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA HOME HEALTH PROVIDER

WCG helps agencies launch compliant Home Health programs by providing licensing support, CMS readiness tools, and full clinical documentation systems.

Scope of Work: