The Division of Policy Coordination and Operations is headed by Deputy Commissioner Sarah Young who is responsible for the development of Medicaid health care coverage, policy and utilization management of all Medicaid benefit programs including; practitioner services, behavioral health and long-term care services, pharmaceutical services, hospital and outpatient clinic services, rehabilitative services, home and community-based services, school based services, and transportation. Areas of responsibility include:
- The Medical Director provides medical expertise to BMS professional staff. Primary activities include: clinical research for policy development, clinical representation of the Medicaid program with external organizations or other governmental departments, clinical research of best medical practices, physician reviewer of medical necessity, prior authorization and denied services appeals, and participates on various committees, associations and boards as a representative of West Virginia Medicaid. Medical Director is Dr. James B. Becker.
- The Office of Facility and Residential Care is responsible for developing, implementing and managing the medical assistance coverage and utilization policies for inpatient hospital, FQHC, facility based services such as Nursing Homes and ICF/MR facilities, and residential services such as Psychiatric Residential Treatment Facilities and Children’s Residential Facilities. Directed Vacant.
- The Office of Professional Services is responsible for developing, implementing and managing the State’s medical assistance coverage and utilization policies for the following services: Out-Patient Services, Practitioner Services, Durable Medical Equipment, Orthotics & Prosthetics, Laboratory, Radiology, Transportation, Podiatry, Chiropractic, Dental, Vision, Occupational/Physical Therapy, and Speech. This office is also ris responsible for the oversight of the Bureau's emergency and non-emergency medical transportation services, including monitoring of the NEMT broker. Directed Vacant.
- The Office of Home and Community-Based Services is responsible for developing, implementing and managing the State’s medical assistance coverage and utilization policies for the following programs: Home Health, Hospice, A/D Waiver, I/DD Waiver, Personal Care, CDCSP, Targeted Case Management, Behavioral Health Clinic and Rehab, Psychological and Psychiatric Services and School-Based Health Services. Directed by Pat Nisbet.
- The Office of Provider Servcies is responsible for the development, coordination and maintenance of the West Virginia Medicaid Program Provider Manuals. In addition to overseeing the distribution of policy, the office is responsible for provider enrollment policy and oversight, West Virgnia Clearance for Access: Registries and Employment Screening Program (WV CARES), ICD 10 compliance, National Correct Coding initiative, and procedure code implementation. Directed Vacant.
- The Office of Special Projects is responsible for the development, management and implementation of projects within the Bureau which requires vital input from key stakeholders. The office is responsible for ensuring Medicaid members, providers, stakeholders and the public are kept informed about the activities of the Bureau. Project management is key component of this office.
- Take Me Home, WV, is a federally funded Money Follows the Person Rebalancing Demonstration Grant Program which assists elderly and individuals with disabilities move from a long-term care setting to a home in the community. This program allows Medicaid to pay for services and supports which are not typically covered by Medicaid. In addition, participants can receive extended direct care services such as extra hours of personal care through one of the waiver programs or the Personal Care Program. Directed by Marcus Canaday.