CASE MANAGEMENT SERVICES PROVIDER IN IDAHO

Fatumata Kaba
Jul 18
3 min read

COORDINATING SERVICES AND SUPPORTS TO PROMOTE HEALTH, INDEPENDENCE, AND COMMUNITY INTEGRATION

Case Management Services in Idaho assist individuals with disabilities, chronic conditions, or aging-related needs by assessing needs, developing care plans, coordinating services, and monitoring progress. These services are authorized under Idaho’s Medicaid Home and Community-Based Services (HCBS) waiver programs and Medicaid State Plan, ensuring participants receive person-centered, comprehensive support to maintain independence in the community.

1. GOVERNING AGENCIES

Agency: Idaho Department of Health and Welfare (IDHW) — Division of Medicaid

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

Agency: Centers for Medicare & Medicaid Services (CMS)

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

2. CASE MANAGEMENT SERVICE OVERVIEW

Case Management Services provide assistance to participants by planning, accessing, coordinating, monitoring, and evaluating services necessary to meet their health, safety, and personal goals.

Approved providers may deliver:

Comprehensive participant assessments and reassessments
Development of individualized care or service plans
Coordination of medical, behavioral, personal support, and community services
Monitoring service delivery and participant health and satisfaction
Advocacy for participant needs and goals
Assistance with transitions (e.g., hospital to home, home to supportive housing)

Services must align with the participant’s Individualized Service Plan (ISP) and reflect a person-centered approach that empowers participants in decision-making.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Idaho Secretary of State
Obtain EIN from the IRS and NPI (Type 2)
Enroll as a Medicaid provider through Idaho Medicaid Provider Enrollment
Ensure case managers meet educational and experience standards (e.g., degrees in social work, nursing, psychology, or human services)
Maintain general liability and professional liability insurance
Develop participant-centered policies for service planning, documentation, coordination, and emergency response

4. IDHW PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Submit Provider Enrollment Application for Case Management Services through Idaho’s Medicaid Management Information System (MMIS)

Application and Documentation Submission:

Submit Articles of Incorporation, proof of EIN/NPI, staff credentialing documentation, insurance certificates, and operational policies
Provide participant intake forms, service plan templates, monitoring checklists, and grievance policies

Program Readiness Review:

IDHW reviews provider readiness, including documentation practices, service monitoring standards, participant protections, and Medicaid billing compliance

Approval & Medicaid Enrollment:

Upon approval, configure billing codes for Targeted Case Management (TCM) and HCBS waiver case management services

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business Registration (Idaho Secretary of State)
IRS EIN confirmation
NPI confirmation
Staff credentials (degrees and relevant licensure if required)
Proof of general and professional liability insurance
HCBS-Compliant Policy & Procedure Manual including:
- Participant intake, comprehensive assessment, and care planning procedures
- Service coordination, referral, and monitoring protocols
- HIPAA confidentiality, participant rights, and grievance handling policies
- Critical incident reporting, emergency preparedness, and risk management
- Staff credentialing, background screening, and training documentation
- Medicaid billing, service tracking, and audit readiness systems

6. STAFFING REQUIREMENTS

Role: Case Management Program Supervisor

Requirements: Bachelor’s or Master’s degree in social work, nursing, psychology, human services, or a related field; supervisory experience preferred; background screening clearance

Role: Case Managers / Service Coordinators

Requirements: Bachelor’s degree minimum; experience with Medicaid populations or disability services; 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 reporting training
Annual competency evaluations and continuing education in case management best practices

7. MEDICAID WAIVER PROGRAMS

The following Idaho Medicaid Waivers authorize Case Management Services:

Developmental Disabilities (DD) Waiver
Aged and Disabled (A&D) Waiver
Children’s Developmental Disabilities Waiver
Medicaid State Plan Targeted Case Management (TCM) Programs

Approved providers may deliver:

Comprehensive service coordination and advocacy
Ongoing monitoring of service effectiveness and participant well-being
Transition planning support for changes in service levels or living arrangements

8. TIMELINE TO LAUNCH

Phase: Business Formation and Initial Credentialing Setup

Timeline: 1–2 weeks

Phase: Staff Hiring, Credentialing, and Program Development

Timeline: 2–3 months

Phase: Idaho Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing System Configuration and Claims Readiness

Timeline: 30–45 days

9. CONTACT INFORMATION

Idaho Department of Health and Welfare (IDHW) — Medicaid Division

Website: https://healthandwelfare.idaho.gov/services-programs/medicaid-health

Centers for Medicare & Medicaid Services (CMS)

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

CASE MANAGEMENT SERVICES PROVIDER IN IDAHO

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

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

Scope of Work:

Business registration and EIN/NPI setup
Medicaid provider enrollment assistance
Development of Case Management Services Policy & Procedure Manual
Staff credentialing templates and participant intake/service planning forms
Medicaid billing system setup and claims management
Website, domain, and email setup
Participant intake, service coordination, and care monitoring documentation systems
Quality assurance programs for participant outcomes and service satisfaction
Community networking and resource referral development strategies