CASE MANAGEMENT SERVICES PROVIDER IN HAWAII

Fatumata Kaba
1 day ago
4 min read

COORDINATING SERVICES, SUPPORTS, AND RESOURCES TO PROMOTE HEALTH, SAFETY, AND COMMUNITY INTEGRATION

Case Management Services in Hawaii assist individuals with disabilities, chronic conditions, or aging-related needs by coordinating and monitoring the services and supports necessary for their well-being. These services are authorized under Hawaii’s Medicaid Home and Community-Based Services (HCBS) waiver programs and Medicaid State Plan services, ensuring participants receive person-centered, comprehensive care in community settings.

1. GOVERNING AGENCIES

Agency: Hawaii Department of Human Services (DHS) — Med-QUEST Division

Role: Oversees Medicaid provider enrollment, service authorization, and reimbursement for Case Management Services

Agency: Hawaii Department of Health (DOH) — Developmental Disabilities Division (DDD)

Role: Administers Case Management under HCBS waivers for individuals with intellectual and developmental disabilities (IDD)

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring Case Management Services meet Medicaid standards for person-centered planning and service coordination

2. CASE MANAGEMENT SERVICE OVERVIEW

Case Management Services assist participants in planning, accessing, coordinating, monitoring, and evaluating services and supports necessary to achieve and maintain community living goals.

Approved providers may deliver:

Comprehensive assessment of participant needs, strengths, and preferences
Development and updating of the Individualized Service Plan (ISP)
Coordination of service delivery across multiple providers and systems
Referral to community resources, medical services, housing supports, and employment programs
Monitoring of participant progress and service effectiveness
Advocacy for participant rights and service access
Crisis intervention and problem-solving support

Case managers must ensure services are delivered in the most integrated setting possible and that all plans are person-centered.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your /business with the Hawaii Department of Commerce and Consumer Affairs (DCCA)
Obtain EIN from the IRS and NPI (Type 2)
Enroll as a Medicaid provider with Hawaii’s Med-QUEST Division
Ensure case managers meet educational and professional standards (e.g., social work, nursing, human services degrees)
Maintain general liability and professional liability insurance
Develop participant-centered policies and procedures for service planning, documentation, and participant advocacy

4. MED-QUEST/DHS PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Submit Provider Enrollment Application for Case Management Services through Hawaii’s Med-QUEST Division
Identify areas of expertise (e.g., IDD supports, long-term services and supports)

Application and Documentation Submission:

Submit Articles of Incorporation, proof of EIN/NPI, case manager qualification documentation, operational policies, and insurance certificates
Provide sample ISPs, service monitoring forms, and crisis intervention protocols

Program Readiness Review:

DHS and DOH review provider readiness, including participant safeguards, service coordination practices, and Medicaid compliance documentation

Approval & Medicaid Enrollment:

Upon approval, configure billing codes for Targeted Case Management (TCM) and HCBS Case Management

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (Hawaii DCCA)
IRS EIN confirmation
NPI confirmation
Proof of general and professional liability insurance
Staff credentials for case managers (degree certificates, licenses if applicable)
HCBS-Compliant Policy & Procedure Manual including:
- Participant intake, assessment, and service planning procedures
- Service coordination, monitoring, and crisis intervention protocols
- Incident reporting, grievance handling, and participant rights procedures
- HIPAA confidentiality, documentation standards, and quality assurance policies
- Medicaid billing, authorization tracking, and audit readiness documentation

6. STAFFING REQUIREMENTS

Role: Case Management Program Supervisor

Requirements: Bachelor’s or Master’s degree in social work, nursing, psychology, or a related field; case management or care coordination experience; background screening clearance

Role: Case Managers / Service Coordinators

Requirements: Bachelor’s degree minimum; knowledge of person-centered planning, service coordination, and Medicaid requirements; background screening clearance

All staff must complete:

Person-centered planning and community integration training
HIPAA confidentiality and participant rights training
Abuse prevention, emergency response, and incident management training
Annual continuing education in Medicaid case management best practices

7. MEDICAID WAIVER PROGRAMS

The following Hawaii Medicaid Waivers authorize Case Management Services:

Developmental Disabilities/Intellectual Disabilities (DD/ID) Waiver
Community Care Services (CCS) Program
QUEST Integration Long-Term Services and Supports (LTSS) Programs

Approved providers may deliver:

Comprehensive case management and service coordination
Crisis intervention and resource linkage
Advocacy and participant support planning
Ongoing monitoring and reassessment of service needs

8. TIMELINE TO LAUNCH

Phase: Business Formation and Initial Credentialing Setup

Timeline: 1–2 weeks

Phase: Med-QUEST Provider Application and Readiness Review

Timeline: 60–90 days

Phase: Staff Hiring, Credentialing, and Service System Setup

Timeline: 30–45 days

Phase: Medicaid Enrollment and Billing System Configuration

Timeline: 45–60 days

9. CONTACT INFORMATION

Hawaii Department of Human Services (DHS) — Med-QUEST Division

Website: https://medquest.hawaii.gov/

Hawaii Department of Health (DOH) — Developmental Disabilities Division (DDD)

Website: https://health.hawaii.gov/ddd/

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

CASE MANAGEMENT SERVICES PROVIDER IN HAWAII

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — HAWAII CASE MANAGEMENT SERVICES PROVIDER

WCG supports case management agencies, care coordination organizations, and disability support providers in launching Medicaid-compliant Case Management Services under Hawaii’s HCBS and Medicaid programs.

Scope of Work:

Business registration and EIN/NPI setup
Medicaid provider enrollment and DHS case management certification support
Development of Case Management Services Policy & Procedure Manual
Staff credentialing templates and participant service planning documents
Medicaid billing system setup and claims management
Website, domain, and email setup
Participant intake, ISP development, and service monitoring templates
Emergency response and crisis intervention procedures
Quality assurance programs for service coordination and participant outcome tracking
Community networking and referral development strategies