1. Program Definition and Services

Respite Care Services in West Virginia provide short-term, intermittent relief to primary family caregivers of individuals with chronic conditions or disabilities. Services are delivered in the client's home or approved community locations across two structural approaches:

• Hourly & Intermittent Respite: Brief, localized supervision, companion care, and assistance with Activities of Daily Living (ADLs) to cover daily caregiver obligations
• Overnight & Multi-Day Respite: Continuous, multi-day support configurations managing medication reminders, behavioral redirection, and comprehensive physical safety monitoring

2. Regulations

• West Virginia DoHS BMS Provider Manual: Dictates distinct policy criteria 
• WV Legislative Rule Title 64 Series 11: Defines regional health and safety parameters for home-based care alternatives

3. Licensing or Certification

Operating entities do not require an independent medical facility license for home-delivered lines of business. However, they must obtain formal Waiver Provider Approval via the Bureau for Medical Services (BMS). 

4. Responsible State Agency

Three structural entities co-manage program criteria:

• WV Department of Human Services (DoHS): Operates through the Bureau for Medical Services (BMS) to direct state policy and fiscal mandates
• Acentra Health: Performs third-party service authorizations, baseline clinical eligibility assessments, and individual service plan reviews
• Gainwell Technologies: Serves as the official state Medicaid fiscal agent, controlling digital credential verification and processing billing actions

5. Application Process

Applicants complete corporate organization through the Secretary of State and apply to the targeted waiver program via BMS. Upon clearing programmatic credential checks, the provider completes formal Medicaid screening through Gainwell Technologies. 

6. Required Documentation

• Secretary of State master business registration certificate and an organizational Type 2 NPI mapped to a respite or home care taxonomy
• Gainwell Technologies Medicaid Waiver Provider enrollment approval letter
• An Operational Policy Manual establishing participant intake, medication reminder constraints, emergency incident recording, and backup staffing workflows
• Clearance logs from the West Virginia Clearinghouse for Affordable and Reliable Employee Screening (WV CARES) for all direct care workers
• Valid CPR and First Aid certifications alongside proof of comprehensive commercial liability coverage

7. Timeline for Approval

Corporate formation, commercial liability tracking, and NPI configuration takes 2 to 4 weeks. Recruiting personnel and logging them into the state fingerprint clearinghouse system requires 3 to 5 weeks. 

8. Pre-Application Process

Prospective providers must finalize their underlying corporate foundation before submitting files for state waiver authorization. This requires legally incorporating via the Secretary of State, activating specialized business tax accounts with the State Tax Department, and obtaining a Federal Employer Identification Number (EIN).

9. Pre-Application Training

While founders do not attend an extended state academy, all Direct Support Professionals (DSPs) must finish critical onboarding modules before delivering services. Workers must clear training covering HIPAA data protection, emergency evacuation protocols, client documentation logs, and mandatory abuse and neglect reporting within their first 60 days of employment.

10. Additional Notes

• Under state rule, any applicant or staff member flagged with a negative felony history or registry match inside the WV CARES portal is immediately barred from direct client access
• Non-medical respite workers are strictly restricted to verbal medication reminders; physical handling or active pouring of medications is legally prohibited without nurse delegation
• The Children with Serious Emotional Disorder Waiver limits respite delivery to community configurations targeting youth, requiring separate trauma-informed care modules for staff
• Respite service volume is strictly governed by pre-set hourly or daily maximum allocations mapped inside the participant's electronic budget file

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