CASE MANAGEMENT SERVICES PROVIDER IN ARIZONA

COORDINATING PERSON-CENTERED SUPPORTS TO ENSURE QUALITY CARE AND ACCESS TO RESOURCES FOR INDIVIDUALS WITH DISABILITIES

Case Management Services in Arizona play a vital role in assessing needs, coordinating services, monitoring progress, and advocating for individuals receiving long-term care under Medicaid. These services are a core component of the Arizona Long Term Care System (ALTCS) and are provided through Home and Community-Based Services (HCBS) Waivers for eligible populations. Depending on the program, case management may be delivered directly by Managed Care Organizations (MCOs) or by contracted community-based providers.

1. GOVERNING AGENCIES

Agency: Arizona Health Care Cost Containment System (AHCCCS)

Role: Oversees ALTCS, HCBS, and case management standards across all Medicaid-funded programs

Agency: Arizona Department of Economic Security (DES) – Division of Developmental Disabilities (DDD)

Role: Directly employs Support Coordinators and monitors Qualified Vendor performance related to case collaboration

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Ensures Medicaid case management services follow federal person-centered planning and care coordination guidelines

2. CASE MANAGEMENT SERVICE OVERVIEW

Case Management Services involve identifying needs, linking individuals to appropriate services, coordinating providers, monitoring care delivery, and advocating on behalf of the person receiving services. The case manager acts as the central point of communication among all stakeholders.

Approved providers may deliver:

• Functional assessments and reassessments

• Development and updating of person-centered service plans (ISPs)

• Coordination of HCBS services, providers, and community supports

• Monitoring of service delivery, satisfaction, and health/safety

• Crisis planning and emergency response coordination

• Documentation of services, progress, and changes in condition

• Advocacy and linkage to non-Medicaid resources when appropriate

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Arizona Corporation Commission

• Obtain EIN from the IRS and NPI (Type 2)

• Contract with MCOs or ALTCS health plans (e.g., Mercy Care, Banner, UnitedHealthcare)

• For DDD vendors: maintain QVADS registration and collaborate with DDD Support Coordinators

• Hire qualified staff with social work, nursing, or case coordination experience

• Maintain professional liability insurance and data security systems

4. ENROLLMENT & CONTRACTING PROCESS

Step 1: Identify Program Path

• Determine if your agency will serve ALTCS/MCO members or support DDD member coordination

• Contact the relevant MCO provider relations department or DDD vendor unit

Step 2: Submit Application

• Include business details, case management model, staff credentials, and quality assurance plan

• Provide sample service plans, tracking tools, and follow-up procedures

Step 3: Credentialing and Contract Execution

• Complete credentialing and system access setup

• Receive case assignments or authorization process training

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License

• IRS EIN Letter

• NPI confirmation

• MCO or DDD vendor contract

• Policy & procedure manual including:

  • Assessment tools and service planning workflow

  • Communication protocols with providers and families

  • Risk and safety planning templates

  • Case notes, service logs, and monitoring reports

  • HIPAA compliance and record retention policies

  • Client rights and informed consent documents

  • Staff supervision, continuing education, and caseload tracking

  • Critical incident management and reporting procedures

6. STAFFING REQUIREMENTS

Role: Case Manager / Service Coordinator

Requirements:

• Bachelor’s degree in social work, nursing, psychology, or related field (Master’s preferred for complex populations)

• 1–2 years of experience in human services, case management, or HCBS coordination

• CPR/First Aid and background check clearance

Role: Clinical Supervisor (if applicable)

Requirements: Licensed professional (e.g., LMSW, RN, LCSW) with supervisory experience

Training Requirements for All Staff:

• Person-centered planning and motivational interviewing

• HCBS waiver program knowledge

• Cultural competence and disability awareness

• Crisis prevention and emergency protocols

• Annual refreshers on documentation, ethics, and care coordination

7. MEDICAID WAIVER SERVICES

Case Management Services are typically embedded in the following Arizona Medicaid Waivers and MCO-managed programs:

• ALTCS – Elderly and Physically Disabled (EPD) Waiver

• ALTCS – Division of Developmental Disabilities (DDD) Waiver

• Children’s Rehabilitative Services (CRS)

• Arizona Early Intervention Program (AzEIP)

• MCO Care Coordination and Transition Programs

Approved providers may deliver:

• Needs assessments and service plan development

• Direct care coordination across multiple providers

• Community resource linkage and problem-solving

• Ongoing documentation of member progress and risk management

8. TIMELINE TO LAUNCH

Phase: Business Formation

Timeline: 1–2 weeks

Phase: MCO or DDD Contracting Process

Timeline: 60–90 days

Phase: Staff Hiring, Credentialing, and System Access

Timeline: 30–45 days

Phase: AHCCCS Billing Configuration (if applicable)Timeline: 30–60 days

9. CONTACT INFORMATION

Arizona Health Care Cost Containment System (AHCCCS)

Email: ProviderRegistration@azahcccs.gov

Website: https://www.azahcccs.gov

Arizona Department of Economic Security (DES) – Division of Developmental Disabilities (DDD)

Email: DDDProviderRegistration@azdes.gov

Phone: (602) 542-6874

Website: https://des.az.gov/services/disabilities/developmental-disabilities

Mercy Care Provider Relations: https://www.mercycareaz.org

Banner University Health Plans – Provider Info: https://www.banneruhp.com

WAIVER CONSULTING GROUP'S START-UP ASSISTANCE SERVICE — ARIZONA CASE MANAGEMENT SERVICES PROVIDER

We help agencies and professionals establish Medicaid-compliant Case Management Services under Arizona’s ALTCS, HCBS, and managed care systems.

Scope of Work:

• Business registration (LLC, EIN, NPI)

• Contracting guidance with DDD and/or MCOs

• Policy & procedure manual for case management and documentation

• Templates for service plans, progress notes, and assessments

• AHCCCS billing setup (if applicable)

• Website, domain, and email setup

• Staff credentialing trackers and supervision logs

• Client intake packet, consent forms, and behavior plans

• Incident reporting systems and audit preparation tools

• Referral networking with providers, hospitals, and community organizations

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.