SKILLED NURSING SERVICES PROVIDER IN WEST VIRGINIA

Fatumata Kaba
2 days ago
4 min read

DELIVERING CLINICAL CARE AND MEDICATION MANAGEMENT TO INDIVIDUALS IN HOME AND COMMUNITY SETTINGS UNDER MEDICAL SUPERVISION

Skilled Nursing Services in West Virginia provide medically necessary, licensed nursing care to individuals with chronic conditions, disabilities, or post-acute recovery needs. These services include wound care, injections, medication management, and clinical monitoring, delivered in home or community-based settings to prevent hospitalization or institutionalization. These services are covered under West Virginia Medicaid, including State Plan benefits and Home and Community-Based Services (HCBS) waivers such as the Aged and Disabled Waiver (ADW) and the Intellectual/Developmental Disabilities (I/DD) Waiver. Oversight is provided by the Bureau for Medical Services (BMS) and the Office of Health Facility Licensure & Certification (OHFLAC).

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1. GOVERNING AGENCIES

Agency: West Virginia Bureau for Medical Services (BMS)

Role: Administers Medicaid reimbursement for skilled services and oversees provider enrollment.

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

Role: Licenses home health agencies and skilled nursing providers for safety, clinical standards, and legal compliance.

Agency: Acentra Health (formerly Kepro)

Role: Conducts utilization reviews, authorizations, and participant assessments for Medicaid waiver services.

2. SKILLED NURSING SERVICES OVERVIEW

Skilled Nursing is intermittent, physician-directed care delivered by a Registered Nurse (RN) or Licensed Practical Nurse (LPN) under RN supervision. Covered services may include:

Wound care and dressing changes
Tube feeding (enteral nutrition)
Medication setup, injections, or IV therapy
Catheter care and management
Blood sugar monitoring and insulin administration
Tracheostomy and ventilator care (case-specific)
Chronic condition management (e.g., CHF, COPD, diabetes)
Clinical documentation and vital sign monitoring
Patient and caregiver education

All services must be authorized in the Individual Service Plan (ISP) or Person-Centered Service Plan (PCSP) and ordered by a licensed physician.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the WV Secretary of State
Obtain EIN and Type 2 NPI
Apply for OHFLAC licensure as a Home Health Agency or specialized Skilled Nursing provider
Complete Medicaid provider enrollment via Gainwell Technologies
Submit Policy & Procedure Manual per OHFLAC and BMS guidelines
Employ licensed RNs and LPNs
Maintain malpractice, liability, and workers’ compensation insurance

4. WEST VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register the business and secure EIN and NPI

Step 2: Apply for OHFLAC licensure and schedule inspection

Step 3: Submit provider enrollment forms to Gainwell Technologies

Step 4: Develop skilled nursing policies and forms per CMS and OHFLAC

Step 5: Credential nursing staff and ensure RN supervision protocols

Step 6: Launch services once authorized in client service plans

5. REQUIRED DOCUMENTATION

OHFLAC license as a Home Health Agency or Nursing provider
WV Medicaid enrollment confirmation
Skilled Nursing Policy & Procedure Manual including:
- Physician order tracking and plan of care documentation
- Medication administration and vital sign logs
- Infection control, hand hygiene, and universal precautions
- RN delegation procedures (if using LPNs)
- Emergency response and on-call coverage plans
- Patient rights, HIPAA compliance, and grievance resolution
- Incident reporting and adverse event documentation
- Nurse credentialing and annual competency evaluations

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)

Requirements:

Licensed by the WV Board of Examiners for Registered Professional Nurses
Responsible for assessments, care planning, oversight of LPNs

Role: Licensed Practical Nurse (LPN)

Requirements:

Licensed by the WV Board of Examiners for Licensed Practical Nurses
May perform delegated tasks under RN supervision

Role: Clinical Supervisor / Administrator

Responsibilities: Oversees staff compliance, care plans, audits, and safety

All staff must complete:

HIPAA and patient confidentiality training
Infection control and universal precautions
Emergency response and incident documentation
Annual skills assessments and CEU tracking
Abuse prevention and mandatory reporter training

7. MEDICAID PROGRAMS THAT COVER SKILLED NURSING

Skilled Nursing may be reimbursed under:

State Plan Home Health Services – Requires physician order and prior authorization
Aged and Disabled Waiver (ADW) – For adults 18+ needing nursing as part of their PCSP
I/DD Waiver – For individuals with developmental disabilities requiring intermittent clinical care
Medically Fragile Children’s Services – Pediatric-focused nursing services
Traumatic Brain Injury Waiver (TBIW) – Case-by-case skilled care support

All services must be listed in the approved service plan.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Licensure Preparation

Timeline: 2–3 weeks

Phase: OHFLAC Application & Inspection

Timeline: 1–2 months

Phase: Medicaid Enrollment & Staff Credentialing

Timeline: 30–45 days

Phase: Launch of Services

Timeline: Begins upon approval and authorization in ISP/PCSP

9. CONTACT INFORMATION

WV Office of Health Facility Licensure & Certification (OHFLAC)