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The Behavioral Health Program is KEPRO’s legacy program in West Virginia.  Since late 2000, KEPRO has provided prior authorizations for behavioral health services, retroactive provider documentation reviews, technical assistance and training to providers, data analysis and member focused activities. 

The Behavioral Health Program promotes coordination of services for West Virginia Medicaid members across payer sources and has expanded to include the following provider types offering behavioral health services to West Virginia Medicaid members:

  • Acute Psychiatric Inpatient Hospitals (for members under age 21 and adults),
  • Partial Hospitalization programs,
  • Psychiatric Residential Treatment Facilities (both in state and out of state),
  • Private Psychiatric and Psychological practitioners,
  • Licensed Behavioral Health Centers,
  • Federally Qualified Health Centers and Rural Health Clinics; and
  • Licensed Independent Clinical Social Workers.

KEPRO - West Virginia staff members in this program have extensive experience working in the West Virginia behavioral healthcare system and all clinical staff members are fully licensed in West Virginia.  Additional services provided by KEPRO include:

  • Training and technical assistance
  • Retrospective care reviews
  • Data analysis and reporting
  • Quality Improvement activities
  • Consumer and community training and education
  • Interagency consultation and collaboration

The state of West Virginia Department of Health and Human Resources Bureau for Medical Services utilizes the following definition of behavioral health, services and supplies that are:

  1. Appropriate and necessary for the symptoms, diagnosis or treatment of an illness
  2. Provided for the diagnosis or direct care of an illness
  3. Within the standards of good practice
  4. Not primarily for the convenience of the plan member or provider
  5. The most appropriate level of care that can be safely provided

To learn more, visit West Virginia Department Health and Human Resources website at http://www.dhhr.wv.gov/.

For a listing of licensed behavioral healthcare providers in West Virginia, visit the West Virginia Bureau for Medical Services’ website at http://www.dhhr.wv.gov/bms.  

For Behavioral Health Manuals and instructions, click here.

For Behavioral Health Retrospective Review Tools, click here

For Behavioral Health Forms & Enrollment information, click here.

For Behavioral Health Data Submission information and instructions, click here.