CASE MANAGEMENT SERVICES PROVIDER IN COLORADO

Fatumata Kaba
Jul 6
3 min read

NAVIGATING LONG-TERM SERVICES AND SUPPORTS (LTSS) TO ENSURE INDIVIDUALIZED CARE AND COMMUNITY INTEGRATION

Case Management Services in Colorado helps individuals with disabilities, chronic conditions, and age-related needs access and coordinate Home and Community-Based Services (HCBS) and other Medicaid supports. Under Colorado’s Medicaid redesign, Case Management is transitioning to a conflict-free model, meaning individuals receiving services must work with case managers not affiliated with direct service providers. Services are authorized by the Colorado Department of Health Care Policy and Financing (HCPF) and delivered through Case Management Agencies (CMAs).

1. GOVERNING AGENCIES

Agency: Colorado Department of Health Care Policy and Financing (HCPF)

Role: Oversees Medicaid and HCBS waiver programs, authorizes case management agencies, and sets compliance standards

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight for Medicaid-funded case management and ensures HCBS compliance

2. CASE MANAGEMENT SERVICE OVERVIEW

Case Management Services help individuals assess their needs, create person-centered plans, coordinate services, and monitor outcomes. This includes ensuring that services are accessible, appropriate, and aligned with the individual’s goals.

Approved providers may deliver:

Comprehensive assessments and level of care determinations
Development and implementation of person-centered service plans
Referral to HCBS waiver and non-waiver resources
Ongoing monitoring of service delivery and progress toward goals
Crisis response planning and reassessments
Documentation and data entry into the state case management system (e.g., Bridge)

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Colorado Secretary of State
Obtain EIN from the IRS and NPI (Type 2)
Apply and be designated as a Case Management Agency (CMA) by HCPF
Demonstrate separation from direct service provision (conflict-free criteria)
Employ qualified case managers with experience in HCBS, social work, or human services
Maintain HIPAA-compliant recordkeeping and secure electronic documentation systems
Carry general liability and professional insurance

4. PROVIDER ENROLLMENT PROCESS

Step 1: Review HCPF Case Management Redesign Requirements

Familiarize yourself with the HCPF CMA Readiness Tool and regional realignment plans

Step 2: Apply for CMA Designation

Submit application, conflict-free attestation, organizational chart, and staff resumes to HCPF

Step 3: Enroll as a Colorado Medicaid Provider

Apply through the Gainwell Provider Web Portal
Submit NPI, ownership details, policies, and procedures

Step 4: System Onboarding and Training

Complete HCPF training modules and Bridge system onboarding

5. REQUIRED DOCUMENTATION

Articles of Incorporation or business registration
IRS EIN Letter
NPI confirmation
CMA designation from HCPF
Colorado Medicaid provider ID
Policy & procedure manual including:
- Intake and eligibility verification forms
- Person-centered service planning templates
- Monitoring and reassessment schedules
- Confidentiality and client rights policies
- Complaint and grievance resolution procedures
- Crisis planning protocols
- Staff training requirements and supervision documentation
- Quality assurance and compliance review tools

6. STAFFING REQUIREMENTS

Role: Case Manager

Requirements:

Bachelor’s degree in social work, nursing, psychology, or related field (or equivalent experience)
Knowledge of HCBS services and Medicaid eligibility
Background check and system access approval
Person-centered planning training (provided by HCPF)

Role: Supervisor / Clinical Reviewer (if applicable)

Requirements:

Clinical or advanced human services background
Oversight of plan approvals, reassessments, and documentation audits

Training Requirements for All Staff:

HCPF-required modules (person-centered planning, critical incident reporting, etc.)
HIPAA and confidentiality
Bridge case management system use
Ongoing CEUs and quarterly refreshers

7. MEDICAID WAIVER SERVICES

Case Management Services are required for participants in:

HCBS-EBD (Elderly, Blind, and Disabled) Waiver
HCBS-DD (Developmental Disabilities) Waiver
HCBS-SLS (Supported Living Services) Waiver
HCBS-CES (Children’s Extensive Support) Waiver
HCBS-CMHS (Community Mental Health Supports) Waiver
Children with Life-Limiting Illness (CLLI) and other Medicaid LTSS programs

Approved providers may deliver:

Intake and eligibility screening
Person-centered service planning and authorizations
Crisis intervention and referrals
Ongoing monitoring and care team coordination
Required data entry and audit-ready documentation

8. TIMELINE TO LAUNCH

Phase: Business Formation

Timeline: 1–2 weeks

Phase: CMA Application and HCPF Review

Timeline: 60–90 days

Phase: Medicaid Enrollment and System Access

Timeline: 30–45 days

Phase: Staff Hiring and Bridge Training

Timeline: 2–4 weeks

9. CONTACT INFORMATION

Colorado Department of Health Care Policy and Financing (HCPF)

Email: hcpf_cmrd@state.co.us

Website: https://hcpf.colorado.gov

Gainwell Technologies – Provider Web Portal

Website: https://portal.co.gov

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

We guide providers through the application, enrollment, and readiness process to become approved Case Management Agencies under Colorado’s Medicaid redesign.

Scope of Work: