CASE MANAGEMENT SERVICES PROVIDER IN IOWA

COORDINATING SERVICES AND SUPPORTS TO PROMOTE HEALTH, INDEPENDENCE, AND PARTICIPANT-CENTERED CARE

Case Management Services in Iowa help individuals with disabilities, chronic conditions, or complex needs access and coordinate the full range of medical, behavioral, social, and community-based services. These services are authorized under Iowa’s Home and Community-Based Services (HCBS) Waiver programs and the Habilitation Services program.

1. GOVERNING AGENCIES

Agency: Iowa Department of Health and Human Services (HHS) — Iowa Medicaid Enterprise (IME)

Role: Administers Medicaid programs, oversees case management service standards, and monitors provider compliance

Agency: Managed Care Organizations (MCOs)

Role: Coordinate case management under Medicaid managed care plans and ensure person-centered service planning

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring case management services comply with HCBS Settings Rule, conflict-of-interest policies, and quality requirements

2. CASE MANAGEMENT SERVICE OVERVIEW

Case Management Services support individuals in navigating Medicaid benefits, identifying appropriate services, and coordinating care across multiple systems. Case managers help participants achieve their goals through individualized service planning, monitoring, advocacy, and resource linkage.

Approved providers may deliver:

• Comprehensive assessments of medical, functional, behavioral, and social needs

• Development of Individualized Service Plans (ISPs) based on person-centered planning

• Coordination of HCBS waiver and non-waiver services (e.g., medical care, housing, employment)

• Ongoing monitoring to ensure services are delivered appropriately and meet the participant’s needs

• Crisis planning and emergency intervention support

• Advocacy for participant rights, informed decision-making, and independence

All services must be conflict-free, meaning case managers cannot be employed by agencies that provide direct services to the participant.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Iowa Secretary of State

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

• Enroll as a Medicaid provider for HCBS Case Management through the Iowa Medicaid Provider Portal (IMPA)

• Maintain general and professional liability insurance

• Meet Iowa’s Conflict-Free Case Management (CFCM) criteria

• Develop compliant policies covering service planning, participant rights, and documentation standards

• Ensure all case managers meet education, training, and background screening requirements

4. IOWA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit application through IMPA to provide case management under applicable waiver or habilitation programs

Documentation Submission:

• Provide Articles of Incorporation, EIN/NPI verification, insurance certificates, staff credentials, background checks, and policy manual

Readiness Review:

• HHS or MCOs may request interviews, sample care plans, or quality assurance tools prior to approval

Approval & Medicaid Enrollment:

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

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Iowa Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Proof of general and professional liability insurance

• Case Management Services Policy & Procedure Manual, including:

  • Participant intake, assessment, and person-centered service planning procedures

  • Conflict-free case management protocols

  • Risk management, emergency response, and crisis planning procedures

  • Participant rights, HIPAA compliance, and grievance policies

  • Staff credentialing, background checks, supervision, and competency evaluations

  • Medicaid billing and service documentation protocols

6. STAFFING REQUIREMENTS

Role: Case Management Supervisor

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

Role: Case Managers / Support Coordinators

Requirements: Bachelor’s degree in human services, social work, psychology, or related field; training in person-centered planning, conflict-free coordination, and HCBS waiver standards; background screening clearance

All staff must complete:

• Abuse prevention and mandatory reporting training

• Person-centered service planning and HCBS Settings Rule training

• HIPAA compliance and participant confidentiality training

• Emergency preparedness and incident response training

• Annual performance evaluations and continuing education

7. MEDICAID WAIVER PROGRAMS AND HABILITATION SERVICES

Case Management Services are reimbursable under:

• HCBS Waivers:

  • Intellectual Disability (ID) Waiver

  • Brain Injury (BI) Waiver

  • Health and Disability (HD) Waiver

  • Elderly Waiver

  • Children’s Mental Health (CMH) Waiver

• Iowa Habilitation Services Program

Approved providers may deliver:

• Initial and ongoing functional assessments

• Service planning and monthly follow-up contacts

• Coordination of Medicaid and non-Medicaid services

• Referrals to housing, behavioral health, vocational, or caregiver supports

• Monitoring and documentation of participant progress

8. TIMELINE TO LAUNCH

Phase: Business Formation, Policy Development, and Conflict-Free Compliance Setup

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development

Timeline: 2–3 months

Phase: Medicaid Enrollment and MCO Readiness Review

Timeline: 60–90 days

Phase: Billing System Setup and Case Management Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

Iowa Medicaid Enterprise (IME)

Website: https://ime.iowa.gov/providers

Iowa Department of Health and Human Services (HHS)

Website: https://hhs.iowa.gov

Managed Care Organizations (MCOs):

• Amerigroup Iowa: https://www.myamerigroup.com/ia

• Iowa Total Care: https://www.iowatotalcare.com

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

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

WCG supports case management agencies, behavioral health providers, and independent support coordination firms in launching Medicaid-compliant Case Management Services across Iowa.

Scope of Work:

• Business registration, Medicaid enrollment, and conflict-free provider compliance

• Development of Case Management Policy & Procedure Manual

• Staff credentialing templates, participant assessment tools, and service tracking forms

• Medicaid billing system setup and audit-ready documentation tools

• Website, domain, and branding setup

• Quality assurance systems for care plan audits, outcome tracking, and participant satisfaction

• Partnership development with waiver case managers, MCOs, and local human service networks

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