Division of Policy Coordination and Operations

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.  This Division is also responsible for all information technology initiatives within the Bureau, including the oversight of the Office of Technology and Reporting, the Quality Unit as well as leading the Bureau's Personnel, Medicaid Information Technology Architecture (MITA) and working with the Department of Health and Human Resources (DHHR) Office of Management Information Services. 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 and 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, Aged and Disabled Waiver (ADW), Intellectual Developmental Disabilities Waiver (IDDW), Traumatic Brain Injury Waiver (TBIW), Personal Care Services, Children with Disabilities Community Service Program (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 (NCCI) 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. 

  • The Office of Technology and Reporting is responsible for the coordination, development and implementation of Health Insurance Portability and Accountability Act (HIPAA) security and continuity of operations methodologies, electronic work flow and collaboration initiatives, legacy application management and quality assurance and performance metrics for the Bureau.  The Office also develops, implements and maintains the Bureau for Medical Services (BMS) SharePoint and internet sites, maintains all hardware and software for the Bureau and is responsible for implementation and maintenance of new technologies such as instant messaging and OCS phone systems, and will be responsible for all reporting within the Data Warehouse (DW) and Decision Support System (DSS)  once developed and implemented.

  • The Medicaid Information Technology Architecture (MITA) Office is responsible for the development, coordination and implementation of processes, procedures and initiatives related to MITA adoption within the Bureau.  This Section was developed to support the Centers for Medicare and Medicaid Services (CMS) objective of an integrated business and information technology transformation in all states in order to improve how Medicaid operates across the Enterprise.   

  • The Quality Unit incorporates sustainable quality assurance and quality improvement principles in the planning, design, delivery, and evaluation of support and services; standardizes the collection, reporting, and monitoring of data, processes, and quality measures in order to support and drive decisions; and develops and implements quality management strategies that support the achievement of positive outcomes for the West Virginia Bureau for Medical Services.  DeeAnn Price manages the quality unit. Directed by Dee Ann Price.

  • The Personnel Section is responsible for the coordination the Bureau’s Human Resources operations. This includes the support for employee Information, payroll, benefits coordination, internal policy, procedures and attendance management.  Kim D. Huffman manages all personnel activities.

  • The Medicaid Management Information System (MMIS) is managed by the Department of Health and Human Resources Office of Management information Services. The Medicaid Management Information System, a claims processing system that processes over 17 million claims annually which accounts for program expenditures in excess of $2.4 billion dollars. The Medicaid program enrolled over 500,000 members as of the end of State Fiscal Year (SFY) 2017 through a network of approximately 32,000 health care providers.

 

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