RESPITE CARE SERVICES PROVIDER IN WEST VIRGINIA

Fatumata Kaba
1 day ago
3 min read

OFFERING TEMPORARY RELIEF FOR CAREGIVERS WHILE ENSURING SAFE, SUPPORTIVE CARE FOR PARTICIPANTS IN HOME OR COMMUNITY SETTINGS

Respite Care Services in West Virginia are designed to provide temporary relief to primary caregivers of individuals with chronic illnesses, disabilities, or age-related conditions. These services give families and caregivers a break from their responsibilities, allowing time to rest, travel, or manage other life demands, while ensuring that participants continue to receive high-quality care. Respite care is available under multiple Medicaid Home and Community-Based Services (HCBS) waivers, including the Aged and Disabled Waiver (ADW), Intellectual/Developmental Disabilities (I/DD) Waiver, and the 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).

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1. GOVERNING AGENCIES

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

Role: Oversees Medicaid waiver services and provider participation.

Agency: Bureau for Medical Services (BMS)

Role: Manages Medicaid billing, claims processing, and policy enforcement.

Agency: Acentra Health (formerly Kepro)

Role: Conducts service authorization, participant assessments, and ISP/PCSP reviews.

2. RESPITE CARE SERVICES OVERVIEW

Respite care is intermittent or scheduled relief that may be provided in the participant’s home, a provider’s residence, or a community setting. Services include:

Supervision and companionship
Assistance with activities of daily living (ADLs)
Medication reminders (not administration)
Meal preparation and light housekeeping
Behavioral redirection and safety monitoring
Engagement in recreational or social activities

Respite may be provided for a few hours, overnight, or multiple days, depending on the participant's plan and caregiver needs.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the WV Secretary of State
Obtain an EIN and Type 2 NPI
Enroll as a Medicaid waiver provider through Gainwell Technologies
Submit a Respite Care Provider application through the applicable waiver program
Ensure staff meet waiver-specific training, background check, and credentialing requirements
Develop a Respite Services Policy & Procedure Manual

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Complete business registration, obtain EIN and NPI

Step 2: Submit provider application to BMS or waiver-specific portal

Step 3: Complete Medicaid provider enrollment via Gainwell Technologies

Step 4: Hire and train staff per waiver guidelines (e.g., CPR, abuse prevention, documentation)

Step 5: Submit Policy & Procedure Manual for review

Step 6: Begin accepting referrals once authorized in ISP/PCSP

5. REQUIRED DOCUMENTATION

WV Secretary of State business registration
Medicaid provider number and contract
Respite Care Services Policy & Procedure Manual, including:
- Participant safety, supervision, and activity planning
- Emergency and incident reporting protocols
- Medication reminder procedures (no administration)
- Documentation of services and time logs
- HIPAA compliance, participant rights, and grievance processes
- Staff training, credentialing, and supervision plans

6. STAFFING REQUIREMENTS

Role: Respite Care Worker / Direct Support Professional (DSP)

Requirements:

Must be 18+ years old
Background check via WV CARES
Trained in abuse prevention, emergency response, and documentation
CPR/First Aid certification (waiver-specific)

Optional Role: RN Supervisor (if participant requires skilled oversight)

Requirements:

Licensed in West Virginia
Available for consultation, but not required for non-medical respite

All staff must complete:

Annual training refreshers
HIPAA and confidentiality training
Waiver-specific documentation procedures
Incident and emergency protocols

7. MEDICAID PROGRAMS THAT COVER RESPITE CARE

Aged and Disabled Waiver (ADW) – In-home respite for adult participants
I/DD Waiver – Includes respite in home or licensed settings
CSEDW (Children with Serious Emotional Disorder Waiver) – Community-based respite for children
TBIW (Traumatic Brain Injury Waiver) – May include limited respite based on the ISP

All services must be documented and pre-approved in the service plan and may be subject to hourly or daily limits.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Enrollment Setup

Timeline: 2–4 weeks

Phase: Staff Hiring & Credentialing

Timeline: 3–5 weeks

Phase: Medicaid & Waiver Provider Approval

Timeline: 1–2 months

Phase: Launch of Services

Timeline: Begins after authorization in ISP/PCSP

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 Registration

Website: https://sos.wv.gov

Gainwell Technologies – WV Medicaid Enrollment

Website: https://www.wvmmis.com

RESPITE CARE SERVICES PROVIDER IN WEST VIRGINIA

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WEST VIRGINIA RESPITE CARE PROVIDER

WCG helps agencies launch Medicaid-compliant respite services by preparing documentation, staff workflows, and compliance systems tailored to West Virginia waivers.

Scope of Work: