1. Program Definition and Services
Behavior Support Services under West Virginia's Medicaid waivers deliver professional clinical consultation and interventions for individuals facing behavioral challenges. Services are engineered to build adaptive skills and secure community integration through:
- Functional Behavior Assessments (FBAs): Clinical evaluations identifying specific environmental triggers and the underlying functions of challenging behaviors
- Behavior Support Plans (BSPs): Creation and ongoing management of individual, positive, non-aversive behavior strategies
- Caregiver Training: Instructing paid agency staff, families, and natural supports on proactive plan implementation and crisis de-escalation
2. Regulations
- West Virginia Bureau for Medical Services (BMS) Medicaid Manual: Chapter 513 (IDDW)
- West Virginia Children with Serious Emotional Disorder Waiver (CSEDW) Frameworks
- Behavior Analyst Certification Board (BACB) Professional Compliance Codes
3. Licensing or Certification
Agencies must be credentialed as an Approved Medicaid Waiver Provider with a specific service endorsement for Behavior Support. Clinical plans must be structured and overseen by a professional holding an active Licensed Behavior Analyst (LBA) credential from the West Virginia Behavior Analyst Licensure Board alongside national BCBA certification.
4. Responsible State Agencies
- West Virginia Department of Human Services (DoHS)
- Bureau for Medical Services (BMS): Manages Medicaid enrollment, provider compliance, and billing frameworks.
- Acentra Health: Acts as the utilization management contractor evaluating clinical eligibility and approving individual prior authorizations.
5. Application Process
- Register business corporate entity with the West Virginia Secretary of State
- Secure a Federal EIN and a Type 2 National Provider Identifier (NPI) matching behavioral health taxonomies
- Apply for waiver provider status through BMS/DoHS
- Complete provider enrollment through the Gainwell Technologies MMIS portal
- Submit all professional therapist licenses (LBA/BCBA) and pass agency background screenings via WV CARES
6. Required Documentation
- Business entity registration and Type 2 NPI documentation
- Verified LBA licenses and national BCBA certificates
- Behavior Support Services Policy Manual detailing FBA workflows, positive intervention standards, strict human rights/restraint prohibitions, crisis protocols, and data collection models
- Completed WV CARES background clearance proofs for all staff
- Commercial general liability and professional malpractice insurance certificates
7. Timeline for Approval
The combined track for entity setup, policy validation, WV CARES processing, and Gainwell enrollment typically spans 3 to 4 months.
8. Pre-Application Process
Incorporate your business in West Virginia, secure an EIN and Type 2 NPI, and secure contracts with fully credentialed LBAs/BCBAs.
9. Pre-Application Training
Clinical supervisors and administrators must complete mandated state waiver onboarding covering billing compliance, CareConnection web portal operations, and incident reporting.
10. Additional Notes
- All clinical frameworks must prioritize positive behavior supports. Restrictive practices or rights modifications are prohibited unless authorized by an Interdisciplinary Team (IDT) and reviewed by a Human Rights Committee (HRC)
- Authorizations are utilization-controlled by Acentra Health and explicitly tied to quantifiable skill-acquisition goals within the member's Person-Centered Service Plan (PCSP)
Why Choose Waiver Consulting Group?
Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies
With proven expertise, a structured process, and ongoing support
To get started, click the link to request portal access