West Virginia - Adult Health Transportation — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

West Virginia’s Bureau for Medical Services (BMS) governs Non-Emergency Medical Transportation (NEMT) under Chapter 524 of the Medicaid Provider Manual, requiring non-ambulance providers to secure a Certificate of Convenience and Necessity from the Public Service Commission (PSC). Providers delivering specialized multi-passenger van transportation (SMPVT) or common carrier services must navigate a bifurcated system depending on the destination of the trip.

Approval to bill Medicaid for general NEMT requires a direct contract with the state's designated transportation Broker, which manages all non-ambulance NEMT dispatch and credentialing. However, transportation specifically to Licensed Behavioral Health Centers (LBHC) or under the Aged and Disabled (Chapter 501), Traumatic Brain Injury (Chapter 512), and Intellectual and Developmental Disabilities (Chapter 513) waivers is exempt from the Broker mandate, allowing direct enrollment with BMS through the Medicaid Management Information System (MMIS).

1. Service Definition and Scope

In West Virginia, Non-Emergency Medical Transportation (NEMT) provides safe, sanitary, and comfortable transport to and from scheduled medical appointments for Medicaid members who have no other means of travel. The service includes Specialized Multi-Passenger Van Transportation (SMPVT) and common carriers.

This service is strictly non-medical in transit. Vehicles and personnel cannot be utilized for the transportation of members requiring Basic Life Support (BLS) or Advanced Life Support (ALS).

• Service Name: Non-Emergency Medical Transportation (NEMT) and Specialized Multi-Passenger Van Transportation (SMPVT).
• Manual Reference: Governed by Chapter 524 (Transportation) of the BMS Provider Manual.
• Scope: Transportation to covered Medicaid appointments and specific waiver services.
• Exclusions: Cannot be used for emergency transport or for patients requiring ALS/BLS monitoring.
• Waiver Exemptions: Trips for Licensed Behavioral Health Center (LBHC) services and specific HCBS waivers bypass the Broker system.

2. Regulatory and Oversight Agencies

The Bureau for Medical Services (BMS) administers the Medicaid program and sets the policy for NEMT under Chapter 524. Actual licensure for non-ambulance transport vehicles is managed by the West Virginia Public Service Commission (PSC).

Day-to-day management, dispatch, and credentialing for general NEMT are outsourced to a state-contracted transportation Broker, while waiver-specific transportation is managed directly through the state's MMIS.

• Medicaid Authority: West Virginia Bureau for Medical Services (BMS) (https://bms.wv.gov/).
• Licensing Authority: West Virginia Public Service Commission (PSC) (http://www.psc.state.wv.us/).
• Broker Entity: State-contracted Transportation Broker (https://bms.wv.gov/ProviderManuals/).
• Provider Enrollment Portal: West Virginia Medicaid Management Information System (WVMMIS) (https://www.wvmmis.com/).

3. Gatekeeping Prerequisites: Who Can Even Apply

The primary structural precondition for general NEMT providers in West Virginia is the mandatory Broker contract. A provider cannot simply enroll in Medicaid and begin billing for general NEMT; they must be accepted into the Broker's network and receive dispatched trips directly from the Broker.

Before approaching the Broker or BMS, the entity must hold specific state authority to operate as a transit provider. Furthermore, providers are strictly prohibited from marketing themselves as medical or ambulance services.

• Broker Contracting: Must secure a contract with the State's transportation Broker for general NEMT reimbursement; standalone Medicaid enrollment is not permitted for general trips.
• PSC Certification: Must hold a Certificate of Convenience and Necessity from the West Virginia Public Service Commission.
• Waiver Exception: Direct BMS enrollment is only permitted for providers exclusively serving LBHC or specific HCBS waiver members (Chapters 501, 512, 513).
• Advertising Restriction: SMPVT providers are strictly prohibited from identifying themselves as ambulance services or using logos implying medical care capacity.

4. Licensure and Certification Requirements

West Virginia does not issue a distinct "Medicaid NEMT License." Instead, providers must meet the commercial transportation requirements set by the Public Service Commission and maintain rigorous vehicle and insurance standards.

Providers must ensure continuous compliance with these standards, as any lapse in PSC certification or insurance immediately disqualifies the provider from the Broker network and Medicaid participation.

• Primary Credential: Certificate of Convenience and Necessity from the WV PSC.
• Vehicle Inspections: All transport vehicles must be inspected annually by the appropriate regulatory authority.
• Insurance Minimums: Must maintain and verify current coverage of errors and omissions liability and/or auto insurance as specified by state law or the Broker.
• Reporting Changes: Modifications to organization, personnel, or fleet must be submitted in writing to BMS Provider Enrollment and/or the Broker within 30 days.

5. Medicaid Provider Enrollment

Enrollment pathways diverge based on the provider's target population. General NEMT providers submit their applications and credentials directly to the state's Broker, adhering to the Broker's specific network enrollment packets.

Providers operating under the LBHC or HCBS waiver exemptions bypass the Broker and enroll directly with BMS through the WVMMIS portal, subject to the general requirements in Chapter 300.

• General NEMT Enrollment: Individuals providing general transportation must enroll directly with the Broker and meet all Broker application requirements.
• Waiver/LBHC Enrollment: Providers exempt from the Broker enroll via the WVMMIS Provider Portal.
• General Requirement: Must meet applicable requirements in Chapter 300, Provider Participation Requirements.
• NPI Requirement: Must obtain and submit a National Provider Identifier (NPI) with the enrollment application.

6. Staffing, Training and Background Checks

While NEMT personnel do not provide medical care, they are responsible for the safe transit of vulnerable populations. West Virginia requires specific life-safety certifications for drivers of multi-passenger vans.

These certifications must be kept current and on file with the credentialing entity (the Broker or BMS) at all times.

• Driver Certification: Multi-passenger van drivers must have current certification in first aid.
• CPR Requirement: Drivers must maintain active cardiopulmonary resuscitation (CPR) certification.
• Documentation: Certification documents must be filed with the Broker or BMS upon enrollment and updated upon renewal.
• Scope of Practice: Personnel may not be utilized for transporting members requiring BLS or ALS monitoring.

7. Documentation, Policies and Records

Providers must maintain comprehensive records of their fleet, personnel, and insurance coverages. The state and the Broker require immediate notification of any changes to the provider's operational capacity.

Trip documentation is critical, especially for Broker-dispatched trips, to verify that the service was delivered as authorized.

• Insurance Verification: Copies of documentation verifying errors and omissions/auto liability compliance must be submitted upon enrollment.
• Driver Files: Must maintain active CPR and First Aid certificates for all multi-passenger van drivers.
• Vehicle Records: Must retain documentation of annual vehicle inspections for every active vehicle in the fleet.
• Fleet Roster: Must maintain an updated list of all vehicles and report modifications within 30 days.

8. Billing, Rates and Claims

Reimbursement for NEMT is dictated by the dispatching authority. The Broker negotiates rates for common carriers and pays claims directly for the general NEMT trips it assigns.

For waiver-exempt trips, providers bill the Medicaid program directly through WVMMIS using established fee-for-service codes.

• Broker Claims: General non-ambulance NEMT claims are submitted directly to and paid by the contracted Broker.
• Waiver Claims: SMPVT providers serving exempt waiver populations submit claims directly to the Medicaid Program via WVMMIS.
• Common Carrier Rates: Services provided by public railways, buses, or cabs are reimbursed at rates negotiated by the Broker.
• Prioritization: Fixed-route transportation must be given priority if appropriate for the member's needs.

9. Approval Sequence and Timeline

Prospective providers must secure their commercial operating authority before attempting to join the Medicaid or Broker networks. The PSC certification is the foundational step.

Once commercial authority and insurance are secured, the provider applies to the appropriate credentialing body based on their service model.

• Step 1: Obtain a Certificate of Convenience and Necessity from the WV Public Service Commission.
• Step 2: Secure required auto and errors/omissions liability insurance.
• Step 3: Complete the Broker credentialing application (for general NEMT) or WVMMIS enrollment (for waiver-exempt NEMT).
• Step 4: Submit driver CPR/First Aid certifications and annual vehicle inspection records to the credentialing entity.

10. Common Denials and Survey Findings

Providers frequently face claim denials or network suspension when they fail to adhere to the strict routing rules between the Broker and direct-billed waiver services.

Additionally, marketing violations regarding the nature of the transportation provided can lead to immediate sanctions.

• Broker Bypass: Claims denied for general NEMT services provided without prior Broker assignment and dispatch.
• Lapsed Certification: Suspension for failure to maintain the PSC Certificate of Convenience and Necessity.
• Marketing Violations: Sanctions for advertising SMPVT services as ambulance or emergency medical services.
• Unreported Changes: Penalties for failing to report fleet or personnel modifications within the required 30-day window.

11. Key Contacts and Resources

Providers should rely on the official Bureau for Medical Services manuals and the Public Service Commission for authoritative guidance on operating requirements.

The WVMMIS portal is the central hub for direct-enrolled waiver transportation providers.

• Bureau for Medical Services: https://bms.wv.gov/
• WV Medicaid Provider Manuals (Chapter 524): https://bms.wv.gov/ProviderManuals/
• WV Public Service Commission: http://www.psc.state.wv.us/
• WVMMIS Provider Portal: https://www.wvmmis.com/

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