1. Program Definition and Services
Home Health Services in West Virginia deliver intermittent skilled clinical interventions, therapy modalities, and structured health monitoring directly to individuals in their residences.
- Skilled Nursing
- Therapy Modalities
- Home Health Aide Support
- Medical Social Work
2. Regulations
- West Virginia Department of Human Services (DoHS) / Bureau for Medical Services (BMS) Home Health Manual
- CMS Medicare and Medicaid Conditions of Participation (CoPs) (42 CFR Part 484)
- Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules
3. Licensing or Certification
An agency must secure a Home Health Agency License from the West Virginia Office of Health Facility Licensure and Certification (OHFLAC), currently housed under the state's Office of Inspector General (OIG).
4. Responsible State Agencies
- Office of Health Facility Licensure and Certification (OHFLAC)
- Bureau for Medical Services (BMS)
- Centers for Medicare & Medicaid Services (CMS)
- Gainwell Technologies
5. Application Process
- Form your legal business entity via the West Virginia Secretary of State
- Obtain an organizational Type 2 National Provider Identifier (NPI) and Federal EIN
- Apply for and clear a Certificate of Need (CON) through the WV Health Care Authority
- Submit a detailed Home Health Agency licensure packet along with complete operational policy manuals to OHFLAC
- Pass an on-site structural licensing survey and initial readiness evaluation
- Submit a Medicaid enrollment application using the Gainwell Technologies portal
6. Required Documentation
- Active West Virginia corporate filing documents and verified EIN/NPI credentials
- Approved OHFLAC Home Health Agency license and an authorized Certificate of Need
- Clinical Operations & Quality Policy Manual outlining skilled nursing protocols, infection control controls, emergency preparedness blueprints, and Plan of Care (POC) tracking
- Standardized physician order templates, clinical assessment forms, and nursing visit logging documents.
- Employee verification files verifying clear WV CARES background checks and active professional board licensing (RN, LPN, PT, OT)
7. Timeline for Approval
Due to the comprehensive nature of the state's Certificate of Need review, detailed clinical policy auditing, and mandatory on-site surveys, the launch timeline typically tracks at 4 to 6 months.
8. Pre-Application Process
Incorporate your entity in West Virginia, secure an EIN and Type 2 NPI, acquire professional malpractice and commercial liability insurance policies, and initiate the preliminary regional Certificate of Need process.
9. Pre-Application Training
Agency operators, directors of nursing (DON), and administrators must complete state-approved orientation training modules. These track the deployment of Oasis data networks, physician-directed plan validation, and CMS billing documentation.
10. Additional Notes
- All delivered services must be strictly directed by a physician-signed Plan of Care (Form CMS-485) and reviewed at regular 60-day intervals to qualify for reimbursement
- Medicaid coverage routes through the State Plan program or as part of specialized waivers like the Aged and Disabled Waiver (ADW) if skilled nursing hours are structurally designated
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
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