CASE MANAGEMENT SERVICES PROVIDER IN CONNECTICUT

COORDINATING MEDICAID, WAIVER, AND COMMUNITY SERVICES TO SUPPORT INDEPENDENCE AND QUALITY OF LIFE FOR INDIVIDUALS WITH DISABILITIES AND COMPLEX NEEDS

Case Management Services in Connecticut ensure that individuals receiving Medicaid or waiver-based services have access to coordinated care tailored to their goals, needs, and preferences. These services are provided under the Connecticut Home and Community-Based Services (HCBS) Waivers, including the Connecticut Home Care Program for Elders (CHCPE), the Personal Care Assistance (PCA) Waiver, the Acquired Brain Injury (ABI) Waivers, and others.

1. GOVERNING AGENCIES

Agency: Connecticut Department of Social Services (DSS)

Role: Administers Medicaid waiver programs and contracts with or oversees qualified case management providers

Agency: Connecticut Department of Developmental Services (DDS)

Role: Provides case management for individuals with intellectual/developmental disabilities under HCBS IDD Waiver

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Ensures federal compliance with person-centered planning and HCBS service coordination standards

2. CASE MANAGEMENT SERVICE OVERVIEW

Case Management (also called Care Management or Service Coordination) includes individualized support to help Medicaid participants access services, monitor progress, and update care plans in response to changing needs.

Approved providers may deliver:

• Comprehensive assessments and person-centered service plans

• Coordination of Medicaid and non-Medicaid services (e.g., transportation, housing, meals, nursing, and therapy)

• Crisis planning and monitoring of safety and health outcomes

• Linkages to behavioral health, home modifications, and durable medical equipment

• Communication with providers, families, and state agencies

• Documentation of case notes, reassessments, and care team meetings

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Connecticut Secretary of the State

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

• Apply to DSS or DDS to become an approved Case Management Agency for a specific waiver (CHCPE, ABI, IDD, PCA)

• Employ or contract qualified case managers (licensed professionals or experienced human services personnel)

• Maintain HIPAA-compliant documentation systems, staff supervision, and audit-ready service logs

• Carry liability and professional insurance

4. PROVIDER ENROLLMENT PROCESS

Step 1: Identify Waiver Program(s)

• Determine whether services will be offered under CHCPE, ABI Waiver, PCA Waiver, or IDD Waiver

Step 2: Submit Case Management Provider Application

• Contact DSS (or DDS for IDD) to request enrollment materials

• Submit agency information, staff credentials, service descriptions, and quality assurance protocols

Step 3: Medicaid Enrollment via DSS

• Enroll through the DSS Medicaid Provider Enrollment Portal with NPI, EIN, and direct deposit info

Step 4: Approval and Service Coordination Activation

• Begin receiving referrals or authorizations from DSS care teams or waiver participants

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or proof of business registration

• IRS EIN Letter

• NPI confirmation

• DSS or DDS approval letter

• Policy & procedure manual including:

  • Initial assessment and care planning tools

  • Reassessment timelines and service plan updates

  • Interdisciplinary team communication templates

  • Consent forms, rights, and confidentiality protections

  • Complaint and grievance resolution processes

  • Crisis intervention and emergency planning procedures

  • Staff training protocols and supervision documentation

  • Electronic or paper documentation systems for case notes and service logs

6. STAFFING REQUIREMENTS

Role: Case Manager / Care Coordinator

Requirements:

• Bachelor’s degree in social work, nursing, public health, or a related field (some waivers may require licensure)

• Experience coordinating services for older adults or individuals with disabilities

• Valid driver's license and ability to travel for home visits (as needed)

Training Requirements:

• Person-centered planning and HCBS waiver compliance

• HIPAA, confidentiality, and documentation ethics

• Crisis planning and protective services reporting

• Cultural competency and client rights

• Annual continuing education and supervisory review

7. MEDICAID WAIVER SERVICES

Case Management Services are funded under:

• Connecticut Home Care Program for Elders (CHCPE)

• Acquired Brain Injury (ABI) Waivers I & II

• Personal Care Assistance (PCA) Waiver

• Medically Complex Children’s Waiver

• IDD Waiver (via DDS)

• Money Follows the Person (MFP) Transition Support

Approved providers may deliver:

• Initial and ongoing person-centered assessments

• Referral, linkage, and monitoring of authorized services

• Regular documentation and collaboration with interdisciplinary care teams

• Support with Medicaid eligibility, service access, and crisis navigation

8. TIMELINE TO LAUNCH

Phase: Business Formation

Timeline: 1–2 weeks

Phase: DSS/DDS Case Management Approval

Timeline: 45–90 days

Phase: Medicaid Enrollment

Timeline: 30–60 days

Phase: Staff Onboarding and System Setup

Timeline: 2–4 weeks

9. CONTACT INFORMATION

Connecticut Department of Social Services (DSS)

Email: dss.ctmedical@ct.gov

Website: https://portal.ct.gov/DSS

Connecticut Department of Developmental Services (DDS)

Email: ddsct.co@ct.gov

Website: https://portal.ct.gov/dds

Connecticut Medicaid Provider Enrollment Portal

Website: https://www.ctdssmap.com

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

We help healthcare agencies, professionals, and nonprofits launch Medicaid-compliant Case Management Services under Connecticut’s HCBS waivers and state-funded programs.

Scope of Work:

• Business registration (LLC, EIN, NPI)

• DSS or DDS provider enrollment and waiver authorization support

• Policy & procedure manual for service coordination and documentation

• Templates for care plans, reassessments, and case notes

• Website, domain, and email setup

• Staff credentialing trackers and supervision logs

• Client intake packet, consent forms, and rights documentation

• Incident reporting systems and audit preparation tools

• Referral networking with hospitals, FQHCs, housing authorities, and case managers

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.