BMS Provider Manual, Chapter 517 Personal Care Services — Provider Participation Requirements (Sections 517.1–517.7.5)

What this rule requires your agency to do

• 1All providers must submit designated continuing-certification evidence to the OA every 12 months, attested by an appropriate agency official; failure triggers pay holds, removal from selection lists, and possible termination (§517.7.2).(BMS Provider Manual, Chapter 517 Personal Care Services — Provider Participation Requirements (Sections 517.1–517.7.5))
• 2PC providers must maintain at least one physical office in West Virginia (not in a private residence), open to the public at least 40 hours per week, with a 24/7 contact method requiring response within 2 hours or less (§517.7).(BMS Provider Manual, Chapter 517 Personal Care Services — Provider Participation Requirements (Sections 517.1–517.7.5))
• 3All direct access personnel must be prescreened through WV CARES; any applicant with a negative finding on a required registry or licensure database is not eligible to be employed (§517.6.1).(BMS Provider Manual, Chapter 517 Personal Care Services — Provider Participation Requirements (Sections 517.1–517.7.5))
• 4Providers must implement Electronic Visit Verification able to track the type of service performed, the individual receiving the service, the date of service, location of service delivery, the individual providing the service, and begin and end times (§517.3).(BMS Provider Manual, Chapter 517 Personal Care Services — Provider Participation Requirements (Sections 517.1–517.7.5))
• 5Applicants without negative findings must submit to fingerprinting for state and federal criminal history checks and may work only as provisional employees not to exceed 60 days, under direct on-site supervision, pending the fitness determination (§§517.6.2, 517.6.4).(BMS Provider Manual, Chapter 517 Personal Care Services — Provider Participation Requirements (Sections 517.1–517.7.5))
• 6A provider agency must have a Certificate of Need (CON) from the WV Health Care Authority and be certified by the Operating Agency (OA) and enrolled as a Medicaid provider before providing PC services (§§517.1, 517.2).(BMS Provider Manual, Chapter 517 Personal Care Services — Provider Participation Requirements (Sections 517.1–517.7.5))
• 7The hiring entity must maintain background check documents (registry findings, fitness determination, any variance, provisional-employment qualification) for the duration of employment; failure may subject the hiring entity to civil money penalties (§517.6.8).(BMS Provider Manual, Chapter 517 Personal Care Services — Provider Participation Requirements (Sections 517.1–517.7.5))
• 8Original required member documentation must be maintained onsite for at least five years from the date of service (or three additional years after audits/dispute resolution), and the POC, RN Assessment, and legal documents must be uploaded to the UMC web portal within twelve calendar days of completion (§517.7.5).(BMS Provider Manual, Chapter 517 Personal Care Services — Provider Participation Requirements (Sections 517.1–517.7.5))