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West Virginia - Personal Emergency Response System — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In West Virginia, Personal Emergency Response Systems (PERS) are funded primarily through the Aged and Disabled Waiver (ADW), a 1915(c) Home and Community-Based Services waiver administered by the Bureau for Medical Services (BMS). The service provides installed or wearable monitoring equipment with 24-hour response capabilities for individuals who live alone or are at risk of falls, allowing them to remain safely in their homes.

To become an approved PERS provider in West Virginia, agencies must navigate Medicaid provider enrollment through the BMS fiscal agent's Provider Enrollment Unit. While West Virginia does not require a specific state license solely for PERS equipment provision, providers must meet all general Medicaid enrollment requirements, including paying the federal application fee, passing background checks, and maintaining a valid West Virginia business license.

1. Service Definition and Scope

Under the West Virginia Aged and Disabled Waiver (ADW), a Personal Emergency Response System (PERS) is defined as an electronic device that enables individuals at high risk of institutionalization to secure help in an emergency. The system is connected to the person's phone and programmed to signal a response center once a "help" button is activated.

The service includes the initial installation of the equipment, monthly monitoring, and maintenance. It is specifically targeted at waiver participants who live alone, or who are alone for significant parts of the day, and have no regular caregiver for extended periods.

2. Regulatory and Oversight Agencies

The primary oversight agency for the ADW program and its services is the West Virginia Department of Human Services (DoHS), Bureau for Medical Services (BMS). BMS sets the policy, rates, and provider qualifications for all Medicaid waiver services.

The day-to-day operational management, including utilization review and prior authorizations, is handled by Acentra Health (formerly Kepro), which serves as the state's contracted utilization management agency.

3. Gatekeeping Prerequisites: Who Can Even Apply

West Virginia does not impose a Certificate of Need (CON) requirement specifically for PERS providers, unlike Personal Care agencies which do require a CON from the WV Health Care Authority. There are no closed networks or moratoria currently blocking new PERS provider applications.

However, any out-of-state provider must be located within a 30-aeronautical mile radius of the West Virginia border to be considered an In-Network provider. Out-of-Network providers beyond this radius can enroll but face strict prior authorization requirements for all non-emergent services.

4. Licensure and Certification Requirements

West Virginia does not issue a specific "PERS Provider License" through the Office of Health Facility Licensure and Certification (OHFLAC). Instead, approval is based on meeting the Medicaid provider enrollment standards and the specific qualifications outlined in the ADW waiver manual.

Providers must maintain standard business credentials and ensure their response centers meet industry standards for emergency monitoring.

5. Medicaid Provider Enrollment

Prospective PERS providers must enroll through the West Virginia Medicaid Enterprise System Administration (WV MESA) portal. The enrollment process requires the submission of a federal application fee, as mandated by 42 CFR 424.514 for institutional providers.

Providers must complete the enrollment application, sign the provider agreement, and submit all required disclosures regarding ownership and control.

6. Staffing, Training and Background Checks

While PERS is primarily an equipment-based service, any staff entering a waiver participant's home for installation or maintenance must meet basic background check requirements. West Virginia requires all waiver providers to ensure their staff do not have disqualifying criminal convictions.

Response center staff must be trained in emergency protocols and be capable of communicating effectively with participants and local emergency responders.

7. Documentation, Policies and Records

PERS providers must maintain detailed records of all installations, maintenance visits, and emergency signals received. Documentation must support the claims billed to Medicaid.

Providers must have written policies regarding equipment testing, response times, and procedures for handling false alarms or equipment failures.

8. Billing, Rates and Claims

PERS services under the ADW are billed using specific HCPCS codes for installation and monthly monitoring. Claims are submitted electronically through the WV MESA system.

Prior authorization is required before any service can be billed. The authorization is generated by Acentra Health based on the participant's approved service plan.

9. Approval Sequence and Timeline

The approval process begins with obtaining a West Virginia business license, followed by submitting the Medicaid provider enrollment application through WV MESA. The state's fiscal agent reviews the application, verifies credentials, and collects the application fee.

Once enrolled, the provider must be selected by a waiver participant and receive a prior authorization from Acentra Health before installing equipment and billing.

10. Common Denials and Survey Findings

Provider enrollment applications are frequently delayed or denied due to incomplete ownership disclosures or failure to pay the required application fee. Out-of-state providers often face issues if they do not understand the 30-mile radius rule for In-Network status.

During audits, common findings include billing for months where the equipment was not tested or failing to maintain documentation of the initial installation and participant training.

11. Key Contacts and Resources

Providers should rely on the Bureau for Medical Services and their fiscal agent for enrollment questions. Acentra Health is the primary contact for authorization and utilization management issues.

The ADW program manual, available on the BMS website, is the definitive source for service definitions and provider requirements.

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