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Policy Coordination

Technical Assistance

Case Planning

Dental/Vision Care

Sterilization & Hysterectomy

Provider Enrollment

Provider Serv/Consumer Claims Review

Your Guide to Medicaid

Contact: medpolcor@wvdhhr.org


Introduction
	The Office of Medical Health Care and Policy Coordination is responsible for overseeing development of Medicaid Program policy overall, and for the appropriate formatting and dissemination of that policy to program participating providers through government organizations and interested parties. In addition to overseeing development and distribution of policy, the office is responsible for the origination of policy in all the areas of medical services relating to physical health to include: hospital, physician, ambulatory surgery, primary care clinics, hospital inpatient and outpatient, and transportation. In addition to specific program areas, the office is also responsible for administration of a number of contracts, including the utilization management contract with West Virginia Medical Institute, a number of professional services consultant contracts. These are in addition to the divisions identified below. Both are matched at 50% FFP administrative

Policy Coordination
top of page	The responsibilities of this unit include coordination and dissemination of policy in the Medicaid Program overall. Direct responsibility for both development and implementation of policy in the program areas of hospital inpatient and outpatient services, ambulatory surgery, federally qualified health centers, rural health clinics, transportation services, and physician services. Additionally, the unit is responsible for administration of a number of professional services consultant contracts. The unit is supervised by a Program Manager. Total staff for the unit is 6. The RN III is matched through federal funds at 75% as medical professional administration. All others are 50% match.

Technical Assistance & Customer Support
top of page	The responsibilities of this unit include administering program policy in the areas of dental and vision care, coordination of patient care, liaison with the Maternal and Child Program, Medicaid provider enrollment, maintenance of provider fee files, and authorization of services in the areas of medical equipment and supplies. Three individuals are matched by federal funds at the 75% FFP as professional Medicaid administrative. All other staff are matched at the 50% FFP for Medicaid administration. Total number of staff in the unit is 29. That includes: The three RN's are matched at 75% FFP as medical professional administrative, all other are matched at 50% FFP for administrative

Case Planning
top of page	Reviews all requests for medical services requiring prior approval and plans with medical providers, case managers and social workers for appropriate home care for Medicaid patients. Case Planning reviews medical services prescribed for the patient that are not available in West Virginia if they can be provided on an outpatient basis. (Prior approval for inpatient services is handled by West Virginia Medical Institute.) These services also include children who are placed in facilities and/or subsidized adoption homes out-of-state as the State of West Virginia is responsible for the child's medical care. Services reviewed for both in-state and out-of-state include durable medical equipment (oxygen, respiratory equipment); surgeries that require prior approval, therapies requiring prior approval (speech, occupational, physical therapy); private duty nursing services, electric wheelchairs, patient lifts, etc. This unit responds to all inquiries regarding Medicaid coverage of the services they handle.

Dental/Vision Care Unit
top of page	This unit manages Medicaid-covered dental and vision care services for the State of West Virginia. Requests are reviewed from dentists and eye care providers and decisions made on coverage. The individual in this unit works with the Optometric, Orthodontist, General Dentist and Ophthalmological Consultants in providing these services. This unit responds to all questions regarding coverage of vision and dental services covered by Medicaid.

Sterilization & Hysterectomy Unit
top of page	This unit reviews all sterilization informed consent forms and hysterectomy acknowledgment forms to be sure that they are completed properly before payment is made for sterilization and hysterectomy services. This unit answers all inquiries regarding Medicaid coverage of sterilization and hysterectomy services

Provider Enrollment
top of page	Reviews requests for medical specialties and determines whether or not the criteria is met for enrollment in the Medicaid Program. Necessary information must be submitted for review so that this decision can be made, i.e., curriculum vitae, specialty board certifications, state licensure, national credentialing agencies certification, etc. This unit handles telephone calls relevant to provider enrollment.

Provider Service and Consumer Claims Review Unit
top of page	These two units are now contracted to ACS/Consultec. See pertinent information below pertaining to ACS/Consultec. ACS/Consultec PROVIDER RELATIONS (Fiscal Agent) (Recipient Eligibility, Claim Status, Billing Instructions, Weekly Payment) Local and out of state-(304) 345-0101 Instate Only- 1-800-433-3019 Mail your claims to the appropriate Post Office Box given below, unless you have been given special mailing instructions otherwise. CLAIM FORM MAILING ADDRESSES ACS, INC., P.O. BOX ? (see below) CHARLESTON, WV 25337

Office of Medical Health Care & Policy Coordination / 350 Capitol Street Room 251 / Charleston, WV 25301-3709