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Alternative Health Care

Psychiatric & Psychological

LONG TERM CARE

Nursing Facilities

Intermediate Care (ICF/MR)

Aged/Disabled (1915c)

Home/Community Waiver

Home Health Service

Children w/Disabilities

Hospice Care

Contact: medbehalt@wvdhhr.org

Alternative Health Care
		Responsible for the MR/DD Waiver program, and medicaid behavioral health clinic and rehabilitation services.

Psychiatric & Psychological
top of page		Responsible for the Aged/Disabled Waiver program, Psychiatric Residential Treatment Facilities, Personal Care and the prior authorization of several behavioral health services.

Nursing Facilities
top of page		The Bureau has worked closely with the Federal Health Care Financing Administration in the implementation of state-of-the-art preadmission screening, and a case-mix system. Reimbursing nursing facilities for additional therapies and services beyond their per diem rates for individuals having a greater acuity level of care reduces hospital costs.
	HIPAA Compliance Issues for Nursing Facilities click here

Intermediate Care (ICF/MR)
top of page		Expenditures for about 650 individuals living in sixty-three ICFs/MR throughout the state amount to a little more than $43,000,000 annually in Medicaid monies. Clients contribute their monthly income (mostly SSI at $484/month) except a $30 personal allowance. The majority of these individuals live in six or eight bedgroup homes.

Aged/Disabled(1915c)
top of page		Federal legislation was passed in 1981 to allow states to provide home and community-based services to individuals requiring a nursing home level of care. Applicants for nursing home care must be given a choice of home care as an alternative to nursing facilities. West Virginia was one of the first states to submit a waiver request and receive approval from the Health Care Financing Administration to implement this program. It was implemented in 1982 and has been renewed three times. Services will be provided to 3,750 individuals statewide during the current state fiscal year. This waiver program has been a safety valve for maintaining the moratorium on the construction of new nursing homes. The services provided to individuals who choose to remain in their own homes cost the Medicaid program more than $40,000,000 during the last state fiscal year. The cost of services provided in a recipient's own home is less than half the expenditures required if these individuals were in nursing facilities.

Home/Community Waiver Service
top of page		The MR/DD Home and Community-Based Services Waiver is an alternative to services provided in an Intermediate Care Facility for people with Mental Retardation (ICF/MR). There are nearly 1,500 individuals receiving a combination of residential and day habilitation (active treatment and training) respite care, transportation, prevocational training, supported employment and service coordination (case management). The assessment process for determining medical eligibility is the same as that for ICFs/MR. Applicants for ICF/MR services must be provided a choice between the ICF/MR and home and community services under the Waiver. The cost of Waiver services is approximately forty percent of the cost of services in an ICF/MR.

Home Health Service
top of page		Home health services in West Virginia's Medicaid program are the same as those provided under the federal Medicare program. Services consist primarily of limited and intermittent skilled nursing and home health aide care. Some of the state's eighty-eight home health agencies also provide physical, occupational and speech therapies. Program eligibility requires a physician's order and oversight responsibility by a registered nurse who implements and monitors the plan of care. Reimbursement rates vary across the state based upon factors utilized by Medicare to establish rates. Until recently, West Virginia Medicaid paid the same rates as Medicare. Recently the Bureau reduced payments to ten percent less than Medicare rates. The state Legislature also passed legislation during the last session to require all new home health providers to obtain a Certification of Need through the Health Care Cost Review Authority.

Children with Disabilities Community Services Program
top of page		This program is limited in scope to children up to age eighteen and in commonly referred to as TEFRA, however, this simply means that Medicaid coverage was extended to a specific population under the Tax Equity and Fiscal Responsibility Act of 1982. Coverage is limited to children who have been denied Social Security Supplemental benefits due to parental income. Applicants must be evaluated and certified by a physician that they require care in a hospital, nursing home or Intermediate care Facility for Mental Retardation. If Medicaid coverage in their own homes enables the applicant to avoid institutionalization or hospitalization, and the costs are less than, or no higher, program eligibility is granted. This is not a program of services designed for this particular population, but provides the services routinely covered by Medicaid. Annual costs are about $2,000,000 and there are' about 140 recipients.

Hospice Care
top of page		Hospice Care is the newest program to be covered by West Virginia Medicaid. Coverage became available in July, 1994 as the result of legislation passed in the 1994 legislative session. In state fiscal year 1996 there were 210 individuals who received services at sometime during the year. Medicaid expenditures are about $1,100,000 annually.

Office of Behavioral Health & Alternative Health Care / 350 Capitol Street Room 251 / Charleston, WV 25301-3709