CASE MANAGEMENT SERVICES PROVIDER IN ILLINOIS

Fatumata Kaba
Jul 18
4 min read

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

Case Management Services in Illinois help individuals receiving Medicaid-funded long-term services and supports by providing comprehensive assessment, care planning, service coordination, and advocacy. These services ensure that participants access the resources they need to remain safe, healthy, and independent in their communities. Case Management is authorized under Illinois Medicaid Home and Community-Based Services (HCBS) Waiver programs and the Medicaid State Plan.

1. GOVERNING AGENCIES

Agency: Illinois Department of Healthcare and Family Services (HFS)

Role: Administers Medicaid funding for Case Management Services, oversees provider enrollment, quality assurance, and reimbursement

Agency: Illinois Department of Human Services (DHS) — Division of Developmental Disabilities (DDD) and Division of Rehabilitation Services (DRS)

Role: Coordinates waiver-specific case management requirements, participant monitoring, and provider oversight

Agency: Illinois Department on Aging (IDoA)

Role: Manages case management activities for older adults under the Community Care Program (CCP)

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring Case Management Services meet HCBS person-centered planning, conflict-of-interest standards, and participant protections

2. CASE MANAGEMENT SERVICE OVERVIEW

Case Management Services support participants by coordinating medical, social, educational, and other supports necessary to maintain or improve functional status and quality of life.

Approved providers may deliver:

Comprehensive needs assessments and risk evaluations
Development of Individualized Service Plans (ISP) or Person-Centered Plans (PCP)
Service coordination and linkage to Medicaid and community-based supports
Monitoring service delivery quality and participant satisfaction
Crisis intervention and critical incident reporting
Advocacy for participant rights, access to benefits, and service adjustments
Transition planning for individuals moving between care settings

Case managers must operate independently of direct service provision, where required to meet CMS conflict-free case management standards.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register a business entity with the Illinois Secretary of State
Obtain EIN from the IRS and NPI (Type 2)
Enroll as a Medicaid Waiver Case Management provider through the Illinois Medicaid Provider Enrollment Portal (IMPACT system)
Obtain IDoA Case Management Certification if providing services under CCP
Maintain professional and general liability insurance
Develop comprehensive policies for assessments, person-centered planning, service monitoring, participant rights protections, and conflict-of-interest mitigation
Ensure case managers meet background screening, credentialing, and ongoing training requirements

4. ILLINOIS PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Submit Provider Enrollment Application through the IMPACT system for Case Management Services under applicable waiver or State Plan programs

Application and Documentation Submission:

Submit Articles of Incorporation, EIN/NPI verification, professional staff credentials, insurance certificates, operational policies, and intake assessment templates

Program Readiness Review:

DHS, HFS, or IDoA conducts reviews of service delivery models, conflict-of-interest safeguards, staff qualifications, participant rights protections, and documentation standards

Approval & Medicaid Enrollment:

Upon approval, providers are assigned billing codes for assessment, service planning, coordination, monitoring, and advocacy activities

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (Illinois Secretary of State)
IRS EIN confirmation
NPI confirmation
IDoA Certification (if serving CCP participants)
Proof of general liability and professional liability insurance
Case Management Services Policy & Procedure Manual, including:
- Participant intake, assessment, and individualized service planning procedures
- Monitoring, service coordination, and advocacy protocols
- Conflict-free case management standards and compliance procedures
- Critical incident reporting, emergency response, and risk management plans
- Participant rights, HIPAA confidentiality standards, and grievance procedures
- Staff credentialing, supervision, and continuing education documentation
- Medicaid billing, documentation tracking, and audit readiness procedures

6. STAFFING REQUIREMENTS

Role: Case Management Program Director / Supervisor

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

Role: Case Managers / Care Coordinators

Requirements: Bachelor’s degree minimum in human services, social work, psychology, nursing, or related field; background screening clearance; Medicaid waiver and person-centered planning training required

All staff must complete:

Person-centered planning and participant rights training
HIPAA compliance and confidentiality training
Abuse, neglect, and exploitation prevention training
Conflict-free case management standards training
Emergency response and critical incident reporting procedures
Annual continuing education and competency evaluations

7. MEDICAID WAIVER PROGRAMS

Case Management Services are available under the following Illinois Medicaid programs:

Adults with Developmental Disabilities Waiver
Children and Young Adults with Developmental Disabilities Waiver
Persons with Brain Injury (BI) Waiver
Persons with Disabilities (PD) Waiver
Elderly Waiver (Community Care Program)
Money Follows the Person (MFP) Demonstration Project

Approved providers may deliver:

Comprehensive intake assessments and risk assessments
Ongoing service plan development and updates
Coordination of home and community-based services
Monitoring and quality assurance for service effectiveness and participant satisfaction
Crisis intervention, advocacy, and transition planning

8. TIMELINE TO LAUNCH

Phase: Business Formation and Program Compliance Preparation

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Care Coordination Program Development

Timeline: 2–3 months

Phase: IMPACT Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing System Setup and Case Management Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

Illinois Department on Aging (IDoA) — Case Management Services

Website: https://ilaging.illinois.gov/

Illinois Department of Healthcare and Family Services (HFS)

Website: https://www.hfs.illinois.gov/

Illinois Department of Human Services (DHS) — Division of Developmental Disabilities and Division of Rehabilitation Services

Website: https://www.dhs.state.il.us/

Centers for Medicare & Medicaid Services (CMS)

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

CASE MANAGEMENT SERVICES PROVIDER IN ILLINOIS

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

WCG assists case management organizations, care coordination entities, and human service agencies in launching Medicaid-compliant Case Management Services across Illinois.

Scope of Work:

Business registration, Medicaid enrollment, and IDoA certification guidance
Development of Case Management Services Policy & Procedure Manual
Staff credentialing templates, assessment forms, care plan templates, and monitoring tools
Medicaid billing system setup and claims management support
Website, domain, and professional branding development
Participant intake workflows, conflict-of-interest compliance systems, and emergency response protocols
Quality assurance programs for service monitoring, outcomes tracking, and participant satisfaction surveys
Referral development with community-based organizations, healthcare providers, and advocacy groups