Division of Policy and Coordination
The Division of Policy Coordination
is headed by Deputy Commissioner Cynthia E. Beane 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 by Nora A. McQuain.
- 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. Directed by Pat A. Woods.
- The Office of Home & 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, MR/DD Waiver, Personal Care, CDCSP, Targeted Case Management, Behavioral health clinic and rehab, Psychological and psychiatric services. Directed by Pat Nisbet.
- The Office of Policy and Administrative Services is responsible for the development, coordination and maintenance of the West Virginia Medicaid Program Provider Manual. In addition to overseeing the distribution of policy, the office is responsible for provider enrollment policy and oversight, grant development, and school based health. Directed by Tanya Cyrus.
- The Office of Pharmacy Services establishes coverage and reimbursement policies for outpatient medications within federal guidelines. Included within the program responsibilities are the federally-mandated prospective and retrospective drug utilization review activities; prior authorization of high-cost, high-risk, drugs and maintenance of a Preferred Drug list. Drug coverage is provided to all Medicaid covered eligibility groups, including recipients enrolled in managed care organizations. Directed by Peggy A. King.