How to start an IDD waiver provider in West Virginia

West Virginia requires a OHFLAC behavioral health license plus Certificate of Need approval and a BMS IDDW provider agreement (case-management-only agencies instead need UMC provider certification) from West Virginia Department of Human Services - Bureau for Medical Services (BMS) (IDDW operation and provider agreements); Office of Health Facility Licensure & Certification (OHFLAC) (license); West Virginia Health Care Authority (CON) to operate an IDD waiver provider.

License required

Yes

License

OHFLAC behavioral health license plus Certificate of Need approval and a BMS IDDW provider agreement (case-management-only agencies instead need UMC provider certification)

Issuing agency

West Virginia Department of Human Services - Bureau for Medical Services (BMS) (IDDW operation and provider agreements); Office of Health Facility Licensure & Certification (OHFLAC) (license); West Virginia Health Care Authority (CON)

Survey and inspection

The UMC (utilization management contractor) conducts IDDW provider reviews with plans of correction; OHFLAC inspects licensed facilities.

Certificate of need

Required

Regulation

BMS Provider Manual Chapter 513 (IDDW), Section 513.2; Chapter 300 (Provider Participation Requirements)

1. Obtain Certificate of Need approval from the WV Health Care Authority (full review or Summary Review), listing any therapy services to be subcontracted
2. Obtain a behavioral health license from OHFLAC (not required for case-management-only agencies, which instead get UMC provider certification)
3. Meet BMS Chapter 300 provider participation requirements and enroll as a WV Medicaid provider
4. Sign the IDDW provider agreement with BMS
5. Set up required staff training records, criminal background checks, office criteria and the IDDW Quality Improvement System

Program

West Virginia Medicaid (Bureau for Medical Services, BMS), including WVCHIP and Mountain Health Trust managed care

Enrollment portal

Provider Enrollment Application Portal (PEAP) on the BMS fiscal agent's site (wvmmis.com)

Fiscal agent

Gainwell Technologies

Application fee

Institutional providers pay the federal application fee, and two separate institutional provider types pay two fees. WV may also charge it to institutional entities that bill fee-for-service, such as personal care agencies, non-emergency transportation providers and residential treatment centers. The fee, or proof it was paid to another program, must come with the application. A hardship exception request goes in with the application; WV Medicaid reviews it and forwards it to CMS for the decision. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.

Fingerprinting

BMS Provider Manual Chapter 300 says high-risk screening includes fingerprint-based background checks. Enrollment is denied or terminated if the provider, or a 5%+ owner, does not submit fingerprints within 30 days of a request. Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check.

Site visit

Screening for moderate- and high-risk providers includes site visits. Enrolling a new practice location, or adding one to an existing moderate- or high-risk enrollment, also requires a site visit.

Revalidation

As part of federal revalidation, providers confirm their enrollment information and update disclosures at set intervals. A screening by Medicare or another state's Medicaid/CHIP within the past five years can be relied on for the federal requirements. Not submitting revalidation documents ends participation. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.

Full West Virginia Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need

Agency

West Virginia Health Care Authority

Services covered

• establishment or acquisition of any health care facility (broadly defined)
• capital expenditures above the expenditure minimum, and capital expenditures to acquire a facility
• substantial changes in bed capacity or health services
• addition of ventilator services by a hospital
• major medical equipment
• new health services not offered on a regular basis
• expansion of hospice or home health agency service areas
• closures or eliminated services tied to capital expenditures

Moratoria

The Authority may not issue CONs for: adding intermediate care or skilled nursing beds (except under §16-2D-11 exemptions); building or replacing skilled nursing facilities (except to replace unsafe facilities or reuse existing licensed beds); adding ICF/IID beds (apart from court-ordered beds); opioid treatment programs (one narrow clinical-trial exception); or adding substance abuse treatment beds in counties that already have more than 250 (W. Va. Code §16-2D-9).

West Virginia certificate of need details →

Model

hybrid

Services in scope

• personal care
• Aged and Disabled Waiver
• TBI Waiver
• IDD Waiver
• home health

Alternate EVV allowed

Yes

Program

https://waiverprograms.wv.gov/electronic-visit-verification-evv

West Virginia EVV requirements →

State minimum wage

$8.75 an hour

Effective

2016-01-01

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Intellectual/developmental disability residential facilities — active organization NPIs (NPPES)

152 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

485,007 (as of Jun 1, 2026)

All West Virginia IDD / waiver Medicaid rates, ranked →

• WV Aged and Disabled Waiver (1915(c))
• WV Children with Serious Emotional Disorder Waiver (1915(c))
• WV Intellectual and Developmental Disability Waiver (1915(c))
• WV Traumatic Brain Injury (TBI) Waiver (1915(c))

West Virginia waivers and waiting lists →