The Bureau for Children and Families of the West Virginia Department of Health and Human Resources has contracted with Aenta, the Managed Care Organization (MCO) who has contracted with KEPRO Intelligent Value to serve as the ASO, or Administrative Services Organization, for socially necessary services. The purpose of the ASO is to provide administrative services necessary to enforce the Department's policies and to complete the authorization process of services in child welfare cases. Socially Necessary has been chosen to designate the class of services governed by this new process.
How to Enroll as a Provider:
Enrollment in the Socially Necessary Services program is currenlty frozen for new providers, however when enrollment is reopened, any individual or agency which meets the designated criteria and submits the appropriate documentation stated in the Request to Provide Services packet the potential provider would receive would be considered. Once all documentation and necessary steps are completed, the Regulatory Management Unit within the Office of Children and Adult Services with the Bureau for Children and Families will then provide a letter of approval or denial to the potential organization/individual and begin the process of setting up the provider to provide the chosen services. As of June 14, 2021, we have opened the Socially Necessary Program for expansion of services and/or counties to existing providers. For approval, a letter of need from the CSM and Community Collaboratives is required. After receiving the letters, the provider will complete an application reflecting the additions and upon verification with Aetna and KEPRO verifying service needs, services and/or service county expansions will be approved.
Any changes in geographic coverage or the provision of additional services will require the submittal of additional information to the ASO and the Department.
Socially Necessary Services (SNS) Provider Forms and Documents
How are Socially Necessary Services Authorized?
Authorization to deliver socially necessary services is obtained from KEPRO Intelligent Value. Authorization is dependent on the provider meeting the qualifications to deliver the service/services, the submittal of all required information to the ASO and the prior approval by the ASO for the delivery of the service/services. The ASO will offer provider training and technical assistance to those who desire to participate.
What is the SNS Process?
Standardized service definitions including units of service;
Establishment of standards for documentation;
Establishment of provider qualifications (credentials);
Authorization and reauthorization of the identified services;
Utilization review process: and
Development of an appeal process.
Once a provider has completed and submitted the enrollment forms, they will need to contact KEPRO Intelligent Value to receive training on how to use the authorization process. The web site for KEPRO Intelligent Value is www.keproqio.com
SNS Communications SOP provides instructions on how to resolve conflicts between ASO providers and Department of Health and Human Resources staff. It is not intended to change policies and procedures for accessing or using necessary services, it is merely a mechanism to resolve problems with services.
All questions or concerns should be sent to firstname.lastname@example.org .