Managing Healthcare Compliance in West Virginia

Sarah Jones
Outline of West Virginia over healthcare photo

West Virginia has distinct regulations and requirements that healthcare providers and organizations must follow. State-specific governing bodies, such as the West Virginia Department of Health and Human Resources (DHHR) and the Bureau for Medical Services (BMS), oversee and enforce these regulations. Effective management of healthcare compliance in West Virginia requires consistent adherence to both federal and state agency standards.

To steer clear of legal or financial repercussions as a result of non-compliance, it’s crucial for organizations in West Virginia to establish robust compliance programs. Healthcare facilities need to develop systems to effectively monitor and apply the state’s compliance requirements. This article explores key elements you need to know to achieve compliance in West Virginia.

West Virginia Healthcare Compliance Resources

Let’s start with the important state government agencies you’ll need to work with:

  • The West Virginia Department of Health and Human Resources (DHHR) is responsible for providing a wide range of essential health and human services to the residents of West Virginia, focusing on public health, healthcare regulation, and social welfare programs.
  • The West Virginia Hospital Association (WVHA) is a collective organization that represents and supports hospitals and health systems across West Virginia, advocating for quality healthcare services and the improvement of health standards within the state.
  • The Bureau for Medical Services (BMS) within DHHR oversees the state’s Medicaid program, providing healthcare coverage and ensuring access to medical services for low-income individuals and families in West Virginia.
  • The West Virginia Board of Medicine is a regulatory body responsible for licensing and overseeing medical practitioners in the state, ensuring they meet professional standards and maintain the highest quality of medical care for the public.
  • The West Virginia Board of Examiners in Counseling (WVBEC) is responsible for the licensing, regulation, and ethical oversight of professional counselors in West Virginia, ensuring they meet the necessary qualifications and adhere to professional standards.

These agencies help maintain the integrity and quality of healthcare services in West Virginia, protecting the public and promoting patient safety. The resources provided by these West Virginia state agencies are essential for promoting public health, ensuring access to healthcare, supporting healthcare professionals, and enhancing overall health outcomes for the residents of West Virginia.

Regulations Unique to West Virginia

To meet the standards of healthcare compliance in West Virginia, there are a few additional regulations.

Certificate of Need Required

With the exception of physicians operating independent practices, most health organizations in West Virginia looking to open or expand facilities are required to obtain a “Certificate of Need” (CON). The program is overseen by the West Virginia Health Care Authority. The certificate is required to prove the community’s need for the proposed service and to regulate the healthcare market, aiming to prevent unnecessary duplication of services. A CON in West Virginia is needed for adding or expanding services that exceed a spending threshold, acquiring major medical equipment, or developing new healthcare facilities. Healthcare leaders are encouraged to consider quality of care, accessibility, and continuity of care before initiating the CON process.

Telehealth Policy

Telehealth policy in West Virginia addresses digital and telecommunication technology, such as video conferencing, for long-distance clinical health care. Medicaid telehealth requires real-time, two-way communication with audio and video equipment. The West Virginia Bureau for Medical Services 2022 Telehealth Provider Manual further expands telehealth to include remote patient monitoring services under certain current procedural terminology (CPT) codes. Providers must obtain patients’ verbal and written consent, outlining rights, risks, benefits, and confidentiality rules Telehealth services in West Virginia are covered if equivalent face-to-face services are also covered, with reimbursement rates negotiated between providers and insurers. 

Tips To Manage Healthcare Compliance in West Virginia

Effectively managing healthcare compliance in West Virginia is a critical responsibility for healthcare organizations, as it ensures the delivery of high-quality care while adhering to legal and regulatory requirements. Here are some key strategies to help healthcare organizations manage compliance effectively:

  • Conduct State-Specific Training: Provide ongoing training and education to staff that is customized to your state’s regulations as well as your facility. If using a learning management system, ensure the vendor offers West Virginia-approved training.
  • Organize Policies By Requirement: Including “WV” in every document that is required by the state will make it much easier for you to find these documents in an online system when a surveyor is onsite. It is also best practice to include the standard you are meeting for additional clarity.
  • Establish a System for Monitoring Risk: Being able to identify compliance risks before they become incidents or violations can save the entire organization time and money. Identifying trends and consistently reviewing reports can signal issues, such as training not being completed or a large number of incidents in one location.
  • Use Compliance Management Software: Accreditation surveyors say organizations that use compliance software are more prepared for onsite visits and surveys. The software helps to keep documents and policies organized, ensures training content is up to date, and makes reporting easy.

By implementing these strategies and fostering a culture of compliance within your healthcare organization, you can effectively manage healthcare compliance, reduce risks, and provide the best possible care to your patients while staying within legal boundaries.

Credentialing Compliance in West Virginia

In West Virginia, the Uniform Credentialing Advisory Committee, established in 2001, streamlines the medical credentialing process for healthcare providers. Appointed by the Department of Health and Human Resources and the Insurance Commissioner, the committee developed standardized forms to simplify initial credentialing and reappointment processes for healthcare entities. These forms are now a mandatory part of the credentialing process for hospitals, health plans, and other healthcare entities, significantly reducing the administrative burden on practitioners and credentialers in West Virginia.

Meet West Virginia Compliance Requirements With MedTrainer 

While the path may be complex, healthcare providers who prioritize compliance will not only avoid legal troubles but also enhance the quality of care they provide to their patients in West Virginia

MedTrainer’s all-in-one compliance platform can streamline management of West Virginia healthcare compliance. MedTrainer seamlessly consolidates your organization’s policies, incident reports, safety plans, HR documents, contracts, and more. This centralized repository ensures all employees have easy access to essential information. The course library is curated to align with regulatory and accreditation requirements, and courses are regularly added and updated to ensure the most current information. Learn more about MedTrainer today!