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West Virginia - Environmental Accessibility Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

West Virginia's Bureau for Medical Services (BMS) funds Environmental Accessibility Adaptations (EAA) primarily through the Aged and Disabled Waiver (ADW) and the Intellectual and/or Developmental Disabilities Waiver (IDDW). Providers of these physical home modifications do not obtain a specialized healthcare facility license; instead, they must hold a standard West Virginia Contractor License issued by the Division of Labor and enroll directly as atypical or typical providers through the state's Medicaid Management Information System (WVMMIS).

Before any EAA work can commence or be billed, the provider must submit an itemized quote to the waiver member's case manager, who then submits the WV-BMS-I/DD-8 Request for EAA form to the state's Utilization Management Contractor (UMC), Acentra, for prior authorization. Without this approved prior authorization in the Atrezzo Next Generation (ANG) system, the provider cannot receive Medicaid reimbursement for the completed adaptations.

1. Service Definition and Scope

In West Virginia, Environmental Accessibility Adaptations (EAA) are defined as physical adaptations to the home, required by the individual's person-centered service plan, that are necessary to ensure the health, welfare, and safety of the individual or that enable the individual to function with greater independence in the home.

These services include the installation of ramps and grab bars, widening of doorways, modification of bathroom facilities (such as roll-in showers), or the installation of specialized electric and plumbing systems necessary to accommodate the medical equipment and supplies that are necessary for the welfare of the individual. Adaptations that add to the total square footage of the home are generally excluded.

2. Regulatory and Oversight Agencies

The West Virginia Department of Human Services (DoHS), Bureau for Medical Services (BMS) is the primary state Medicaid agency responsible for overseeing the waiver programs that fund EAA services. BMS sets the policy, coverage limits, and provider qualifications for home modifications.

Because EAA involves construction and structural modification, the West Virginia Division of Labor acts as the primary licensing body for the contractors performing the work. Additionally, Acentra (formerly Kepro) serves as the Utilization Management Contractor (UMC) responsible for reviewing and approving all EAA prior authorization requests.

3. Gatekeeping Prerequisites: Who Can Even Apply

West Virginia does not require a Certificate of Need (CON) or a specialized healthcare facility license to become an EAA provider. There are no closed networks, moratoria, or mandatory managed care subcontracting requirements specifically blocking enrollment for waiver-funded home modifications.

The structural precondition to applying for Medicaid enrollment as an EAA provider is possessing a valid West Virginia Contractor License for any project exceeding the state's statutory cost threshold for unlicensed handyman work. Providers must also be registered to do business in the state with the West Virginia Secretary of State.

4. Licensure and Certification Requirements

West Virginia does not issue a distinct "Medicaid EAA Provider License." Instead, providers must meet the state's standard occupational and business licensing requirements for construction and home modification. Any individual or business performing construction, modification, or repair work in West Virginia where the total cost of the project (materials and labor) exceeds $5,000 must hold a West Virginia Contractor License.

Providers must ensure that all modifications are completed in accordance with applicable state and local building codes. For specialized equipment like stair lifts, providers may also need to meet specific manufacturer certification requirements to ensure safe installation.

5. Medicaid Provider Enrollment

To bill for EAA services, contractors must enroll as West Virginia Medicaid providers through the WVMMIS portal, managed by Gainwell Technologies. Providers typically enroll as atypical providers if they do not provide standard medical services, meaning they may not need a National Provider Identifier (NPI) depending on their exact classification, though standard DME providers performing EAA will use their NPI.

During enrollment, providers must submit proof of their West Virginia Contractor License, W-9, and complete the Electronic Funds Transfer (EFT) authorization via the West Virginia State Auditor's website to receive payments.

6. Staffing, Training and Background Checks

Because EAA providers are typically construction contractors rather than direct care staff, they are not subject to the same intensive clinical training requirements as personal care aides or nurses. However, they must comply with basic Medicaid program integrity standards.

Providers are strictly required to check all current and future employees, subcontractors, and agency staff against state and federal exclusion databases. West Virginia Medicaid prohibits payment for any services rendered by individuals excluded from federal health programs.

7. Documentation, Policies and Records

EAA providers must maintain detailed records of the modifications requested, approved, and completed. The foundational document is the WV-BMS-I/DD-8 Request for Environmental Accessibility Adaptation form, which is completed by the member's case manager but requires the contractor's itemized quote.

Providers must supply an invoice on official contractor letterhead that itemizes all materials and labor. After completion, documentation must be kept showing that the work was finished satisfactorily and in compliance with the approved prior authorization.

8. Billing, Rates and Claims

EAA services are reimbursed based on the approved itemized quote rather than a standard statewide fee schedule per unit. The total amount billed cannot exceed the amount authorized by Acentra in the prior authorization.

Claims are submitted electronically through the WVMMIS portal. Providers must ensure they bill using the correct procedure codes specified in their authorization and must not bill for any work until the modification is fully completed and usable by the member.

9. Approval Sequence and Timeline

The process begins with the provider enrolling in WVMMIS, which can take 30 to 60 days. Once enrolled, the provider evaluates the member's home and provides an itemized quote to the waiver case manager.

The case manager submits the WV-BMS-I/DD-8 form and the quote to Acentra. Acentra reviews the request for medical necessity and cost-effectiveness. Once the PA is issued in the Atrezzo system, the contractor completes the work and subsequently submits the claim to WVMMIS for payment.

10. Common Denials and Survey Findings

Claims for EAA are most frequently denied due to a lack of prior authorization or a mismatch between the billed amount and the authorized amount. If a contractor begins work before Acentra approves the PA, those costs will not be reimbursed.

During Payment Error Rate Measurement (PERM) audits, common findings include missing documentation of the itemized quote, failure to verify staff against exclusion lists, or billing for modifications that are considered general home maintenance (e.g., roof repair) rather than accessibility adaptations.

11. Key Contacts and Resources

Providers should utilize the official state portals for enrollment, billing, and prior authorization. The Bureau for Medical Services provides policy manuals, while Acentra handles the day-to-day authorization reviews.

For questions regarding contractor licensing, providers must contact the West Virginia Division of Labor.

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