1. Program Definition and Services

Individual and Family Support Services under West Virginia’s Medicaid waivers deliver specialized instruction, clinical counseling, and structured coaching to the caregivers, parents, guardians, and families of waiver participants. These family-directed interventions aim to improve home stability, reduce the risk of caregiver burnout, and equip natural support networks with the skills required to manage complex diagnoses or behaviors safely. Services include:

• Family and Caregiver Training
• Family Counseling Services 
• Behavior Support Coaching
• Peer Support Facilitation

2. Regulations

• West Virginia Department of Human Services (DoHS) Bureau for Medical Services (BMS) Care Policies
• The CMS Home and Community-Based Services (HCBS) Settings Final Rule 
• Health Insurance Portability and Accountability Act (HIPAA)

3. Licensing or Certification

Provider organizations must hold active authorization as a Medicaid Waiver Provider through BMS for specialized family support categories. Clinicians delivering professional therapeutic counseling components must be actively licensed by their corresponding state oversight entities, such as the West Virginia Board of Examiners in Counseling (for LPCs) or the West Virginia Board of Social Work (for LCSWs). 

4. Responsible State Agencies

• West Virginia Department of Human Services (DoHS): Serves as the overarching state administrative agency managing safety, behavioral health, and long-term waiver resources across West Virginia
• Bureau for Medical Services (BMS): Operates directly under DoHS to control Medicaid program funding, publish manual updates, evaluate initial agency enrollment packets, and monitor audit compliance
• Acentra Health: Functions as the state utilization contractor tasked with reviewing clinical data, authorizing specific service units, and ensuring family supports map directly to the participant's approved Individualized Service Plan (ISP)
• Gainwell Technologies: Directs the West Virginia Medicaid Management Information System (MMIS), handling secure portal registrations, provider mapping, and outbound waiver claims routing

5. Application Process

• Register your legal corporate structure (LLC or Corporation) with the West Virginia Secretary of State’s Business Services Division
• Establish a Federal Employer Identification Number (EIN) and secure an organizational Type 2 National Provider Identifier (NPI)
• Author a dedicated Individual & Family Support Services Policy & Procedure Manual aligned with current West Virginia DoHS guidelines
• Execute and compile professional credentials or formal licensure validations for all contracted therapists, trainers, and family specialists
• Complete the initial provider credentialing application through the Bureau for Medical Services (BMS)
• Finalize your automated billing configuration by enrolling via the Gainwell Technologies MMIS portal

6. Required Documentation

• Active West Virginia corporate business registration and valid professional licenses (LPC, LCSW) for counseling personnel
• Certificates of insurance for comprehensive general commercial liability, professional clinical malpractice, and workers' compensation coverage
• Individual & Family Support Services Policy & Procedure Manual outlining intake protocols, family confidentiality constraints, trauma-informed care delivery frameworks, crisis intervention blueprints, caregiver grievance tracks, and service satisfaction tracking metrics
• Documented training curricula, workshop outlines, and parent educational materials slated for delivery
• Background checks through the WV CARES portal for all personnel entering consumer households or interacting with family units
• Service notes and electronic tracking templates showing family progression toward targeted ISP benchmarks

7. Timeline for Approval

The required period to complete business formulation, build your internal specialized documentation, pass BMS structural compliance reviews, and activate standard electronic data systems through Gainwell tracks at 2 to 3 months.

8. Pre-Application Process

Prior to requesting state enrollment, the enterprise must complete its legal incorporation, claim its corporate EIN and Type 2 NPI, procure insurance certificates, and confirm contractual agreements with licensed behavioral health professionals or credentialed family specialists.

9. Pre-Application Training

Agency directors, clinical leads, and administrative billing staff are required to complete state waiver orientation training. These modules highlight person- and family-centered practice philosophies, specific documentation criteria for family training elements, and Acentra Health prior authorization workflows.

10. Additional Notes

• Individual and Family Support Services must always be tied directly to a goal within the participant's overarching ISP, these services are not generic family assistance programs and must specifically enhance the care environment of the waiver recipient
• Progress notes must explicitly detail the family's participation level, their response to specialized coaching techniques, and objective changes observed in caregiver capacity or family stability over time

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 & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

To get started, click the link to request portal access