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West Virginia - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

West Virginia funds non-medical supervision and socialization through Person-Centered Support (PCS) under the Intellectual/Developmental Disabilities Waiver (IDDW) and the state plan Personal Care program, rather than using a standalone Adult Companion Services definition. The Bureau for Medical Services (BMS) oversees these programs, utilizing Acentra Health as the Administrative Services Organization (ASO) to manage waiver operations and provider qualifications.

Agencies seeking to provide these services under the state plan Personal Care program must secure a Certificate of Need (CON) from the West Virginia Health Care Authority before submitting a Certification Application to the Operating Agency. Once the CON and operating certifications are secured, providers submit their enrollment applications through the West Virginia Medicaid Management Information System (WVMMIS) portal to receive a billing number.

1. Service Definition and Scope

Because West Virginia does not operate a distinct Adult Companion Services category, providers deliver non-medical supervision, socialization, and community integration under the IDDW Person-Centered Support (PCS) service or the state plan Personal Care program. These services ensure the member's health and safety while promoting independence in the home and community.

PCS encompasses tasks that might otherwise be split into companion, homemaker, and personal care in other states. Services may not solely involve ancillary tasks such as housekeeping; they must directly support the member's assessed needs.

2. Regulatory and Oversight Agencies

The West Virginia Department of Human Services (DoHS), Bureau for Medical Services (BMS) is the single state Medicaid agency responsible for program rules and funding. BMS contracts with external entities to manage day-to-day waiver operations and provider enrollment.

Acentra Health serves as the ASO for the IDDW program, handling utilization management and provider qualification reviews. The West Virginia Health Care Authority regulates market entry for personal care agencies through the Certificate of Need process.

3. Gatekeeping Prerequisites: Who Can Even Apply

West Virginia imposes a strict market-entry barrier for agencies providing state plan Personal Care services. Applicants must obtain a Certificate of Need (CON) from the West Virginia Health Care Authority before any Medicaid enrollment application is accepted.

Certain entities are explicitly exempt from the CON requirement under Chapter 517 rules. If an agency does not meet an exemption, it must successfully navigate the CON public review process, proving unmet geographic need, which can take several months and is subject to competitor opposition.

4. Licensure and Certification Requirements

After securing a CON (if applicable), Personal Care provider applicants must submit a Certification Application to the Operating Agency. This certification verifies that the agency has the administrative and operational infrastructure to deliver services safely.

IDDW providers must be approved by the BMS and Acentra Health, demonstrating compliance with waiver-specific policies, including the HCBS Settings Rule and incident management protocols.

5. Medicaid Provider Enrollment

Provider enrollment is conducted electronically through the WVMMIS Provider Enrollment portal. Applicants must complete all required fields, sign the Provider Agreement, and upload proof of current licensure, certification, or CON.

Federal regulations require institutional providers billing on a fee-for-service basis, such as personal care agencies, to pay an application fee during enrollment and revalidation, unless they have already paid it to Medicare or another state's Medicaid program.

6. Staffing, Training and Background Checks

Direct care workers providing Person-Centered Support or Personal Care must meet state-defined competency and background check standards. Agencies are responsible for ensuring all staff complete required training before delivering billable services.

West Virginia requires comprehensive background screening to protect vulnerable adults. Staff must be trained on member rights, incident reporting, and specific care plans.

7. Documentation, Policies and Records

Providers must maintain comprehensive records that justify the services billed to WV Medicaid. Documentation must align with the member's individualized service plan and clearly detail the dates, times, and specific tasks performed.

Agencies must also maintain administrative policies covering conflict of interest, electronic visit verification (EVV) compliance, and quality assurance.

8. Billing, Rates and Claims

Claims for PCS and Personal Care are submitted through the WVMMIS portal using standard HIPAA-compliant formats (e.g., 837I or 837P). Providers must bill according to the procedure codes and modifiers specified in the current BMS fee schedules.

Rates are established by the Bureau for Medical Services and are published on the BMS website. Providers cannot bill for services provided by an Out-of-Network provider without prior authorization.

9. Approval Sequence and Timeline

The approval process is strictly sequential. An agency cannot apply for Medicaid enrollment until it has secured its business license and, if applicable, its Certificate of Need from the Health Care Authority.

Once the CON and Operating Agency certification are obtained, the WVMMIS enrollment process typically takes 30 to 60 days, provided the application is complete and all background disclosures are accurate.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to missing documentation, such as failing to upload a valid CON or proof of exemption. Incomplete ownership disclosures also trigger automatic enrollment pauses.

During operational surveys, common citations include failure to maintain current background checks, inadequate documentation of service delivery times, and non-compliance with EVV mandates.

11. Key Contacts and Resources

Providers should rely on official state resources for the most current manuals, fee schedules, and enrollment checklists. The BMS and WVMMIS websites are the primary hubs for policy updates.

For waiver-specific operational questions, Acentra Health provides provider relations support and training materials.

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