SPECIALIZED THERAPY SERVICES PROVIDER IN WEST VIRGINIA

Fatumata Kaba
2 days ago
4 min read

DELIVERING CUSTOMIZED OCCUPATIONAL, PHYSICAL, SPEECH, AND BEHAVIORAL THERAPIES TO SUPPORT INDIVIDUAL GROWTH AND FUNCTIONAL INDEPENDENCE

Specialized Therapy Services in West Virginia are designed to help individuals with disabilities, developmental delays, or chronic conditions improve mobility, communication, sensory processing, behavioral regulation, and daily living skills. These therapies are delivered as part of a participant’s Individualized Service Plan (ISP) under Medicaid waiver programs or through Medicaid State Plan services. Specialized therapies are often included in the Intellectual/Developmental Disabilities (I/DD) Waiver, Children with Serious Emotional Disorder Waiver (CSEDW), and Traumatic Brain Injury Waiver (TBIW). Oversight is provided by the West Virginia Department of Health and Human Resources (WVDHHR) and the Bureau for Medical Services (BMS).

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1. GOVERNING AGENCIES

Agency: West Virginia Department of Health and Human Resources (WVDHHR)

Role: Manages waiver programs and monitors service quality.

Agency: Bureau for Medical Services (BMS)

Role: Handles Medicaid billing, provider enrollment, and documentation review.

Agency: Acentra Health (formerly Kepro)

Role: Reviews therapy needs during assessments and authorizes ISP service plans.

Agency: West Virginia Board of Examiners (PT, OT, SLP, etc.)

Role: Licenses therapists and enforces professional standards.

2. SPECIALIZED THERAPY SERVICES OVERVIEW

Specialized Therapy Services include individualized treatment to help participants reach developmental or functional goals. These services must be prescribed or recommended in the ISP and documented by a licensed professional.

Therapies may include:

Occupational Therapy (OT): Fine motor skills, sensory integration, ADLs
Physical Therapy (PT): Gross motor function, strength, balance, mobility aids
Speech-Language Pathology (SLP): Communication skills, feeding, swallowing
Behavioral Therapy / Applied Behavior Analysis (ABA): Behavior modification, social-emotional development
Recreational or Music Therapy (as allowed by waiver)
Feeding therapy or sensory therapy (if clinically justified)

Services can be delivered in-home, in clinic, or within day/residential programs, and must be tied to measurable ISP goals.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the WV Secretary of State
Obtain an EIN and Type 2 NPI
Apply to become a waiver or Medicaid-enrolled therapy provider
Ensure all clinicians hold active West Virginia licensure in their discipline
Submit a Specialized Therapy Services Policy & Procedure Manual
If offering services in a facility, meet any OHFLAC licensure or safety requirements

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business and secure EIN and NPI

Step 2: Apply through BMS to become a waiver therapy services provider

Step 3: Complete Medicaid provider enrollment through Gainwell Technologies

Step 4: Submit Policy & Procedure Manual and documentation of therapist credentials

Step 5: Develop documentation tools aligned with ISP goals and billing requirements

Step 6: Begin providing services once participant authorization is secured

5. REQUIRED DOCUMENTATION

Business registration, Medicaid provider agreement
Therapist licenses and certification records
Specialized Therapy Services Policy & Procedure Manual including:
- Intake and assessment processes
- Therapy treatment plan development
- Session documentation templates
- Progress monitoring and goal adjustment
- Safety, infection control, and equipment sanitization protocols
- HIPAA and patient rights policies
- Authorization and service tracking aligned with ISP goals
- Discharge or transition documentation procedures

6. STAFFING REQUIREMENTS

Role: Licensed Therapist (OT, PT, SLP, LBA, etc.)

Requirements:

Active West Virginia license
CPR/First Aid certification
WV CARES background check
Trained in HIPAA, abuse prevention, and service-specific techniques

Role: Therapy Assistant (COTA, PTA, SLPA – if applicable)

Requirements:

Licensed or certified under WV board requirements
Must work under the supervision of a licensed therapist

All clinical staff must complete:

Ongoing CEUs required by the licensure board
Waiver-specific training on documentation and Medicaid billing
Emergency protocols and safety drills

7. MEDICAID PROGRAMS THAT COVER THERAPY SERVICES

I/DD Waiver – Covers habilitative therapies related to function, behavior, and independence
CSEDW – Authorizes emotional, behavioral, and speech therapy for youth
TBIW – May approve PT, OT, or speech therapy to address deficits caused by brain injury
State Plan Medicaid – May cover therapy when medically necessary and physician-ordered

All therapies must be linked to the participant’s service plan and authorized through Acentra Health or applicable utilization review.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Staffing Plan

Timeline: 2–4 weeks

Phase: Medicaid Waiver Enrollment & Policy Submission

Timeline: 1–2 months

Phase: Staff Credentialing & Clinical Documentation Setup

Timeline: 30–45 days

Phase: Launch of Services

Timeline: Begins after authorization of ISP goals and service approval

9. CONTACT INFORMATION

WV Bureau for Medical Services (BMS)