CASE MANAGEMENT SERVICES PROVIDER IN KENTUCKY

Fatumata Kaba
Jul 25
4 min read

COORDINATING CARE, EMPOWERING PARTICIPANTS, AND SUPPORTING OUTCOMES THROUGH PERSON-CENTERED SERVICE PLANNING

Case Management Services in Kentucky are a core component of Medicaid’s Home and Community-Based Services (HCBS) waiver programs. Case managers serve as the primary coordinators of services, ensuring that participants receive timely, appropriate, and person-centered support in the least restrictive environment. Through ongoing assessment, care planning, and service monitoring, case managers help participants maintain independence and improve quality of life.

1. GOVERNING AGENCIES

Agency: Kentucky Cabinet for Health and Family Services (CHFS) — Department for Medicaid Services (DMS)

Role: Establishes provider qualifications, care planning requirements, and billing procedures for case management

Agency: Kentucky Department for Aging and Independent Living (DAIL)

Role: Provides oversight and quality assurance for case managers operating under aging and disability waivers

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Ensures that case management services comply with federal Medicaid rules for person-centered planning, conflict-free case management, and participant rights

Agency: Managed Care Organizations (MCOs)

Role: Approve and monitor care plans, authorize services, credential providers, and process billing for HCBS participants

2. SERVICE OVERVIEW

Case Management Services assist participants with assessing needs, identifying service options, coordinating providers, and monitoring outcomes. Services are delivered in accordance with the participant’s Person-Centered Service Plan (PCSP).

Approved activities include:

Comprehensive needs assessments and reassessments
Development and updates of the PCSP
Coordination of waiver and non-waiver services (e.g., medical, behavioral, housing)
Facilitating interdisciplinary team meetings
Monitoring health and safety status
Addressing gaps in care or changes in condition
Advocacy and crisis intervention
Documentation and reporting to DMS or MCO

All case management must be conflict-free, meaning the case manager cannot deliver or have a financial interest in other HCBS services received by the participant.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Kentucky Secretary of State
Obtain IRS EIN and Type 2 NPI
Enroll through the Medicaid Partner Portal Application (MPPA)
Maintain general liability and professional liability insurance
Employ or contract with qualified case managers (social workers, nurses, or human service professionals)
Develop a Case Management Services Policy & Procedure Manual
Ensure HIPAA compliance, quality assurance procedures, and secure documentation systems

4. KENTUCKY PROVIDER ENROLLMENT PROCESS

Step 1: Medicaid Enrollment via MPPA

Apply as a Case Management Provider under the relevant HCBS waiver program
Complete MCO credentialing for waiver-based case management

Step 2: Documentation Submission

Submit proof of licensure, staff qualifications, insurance coverage, and program policies

Step 3: Program Implementation

Establish referral networks, intake procedures, and care coordination workflows
Begin service delivery per PCSP authorization and submit documentation for billing

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Kentucky business license
IRS EIN and NPI verification
Professional liability and general liability insurance
Case Management Policy & Procedure Manual, including:
- Intake and assessment templates
- Person-Centered Service Plan (PCSP) documentation
- Care coordination logs and service referral tracking
- Risk mitigation, incident reporting, and follow-up forms
- HIPAA and participant consent forms
- Staff credentialing and ongoing training logs
- Monthly monitoring and quarterly reassessment tools
- Medicaid billing templates and audit readiness protocols

6. STAFFING REQUIREMENTS

Role: Case Manager

Requirements: Bachelor’s or Master’s degree in social work, nursing, or a human services field; minimum of one year of experience with the waiver’s target population; cleared background check

Role: Program Supervisor (optional)

Requirements: Responsible for oversight of documentation, quality assurance, and staff development

All staff must complete:

Person-centered planning training
HIPAA and participant rights education
Abuse, neglect, and exploitation prevention training
Emergency response and crisis management protocols
Annual continuing education to maintain licensure and program quality

7. MEDICAID PROGRAMS & HCBS WAIVERS

Case Management Services are authorized under:

Home and Community-Based (HCB) Waiver
Michelle P. Waiver (MPW)
Supports for Community Living (SCL) Waiver
Acquired Brain Injury (ABI & ABI-LTC) Waivers
Model II Waiver (MIIW)

Delivery settings may include:

Participant’s home
Community settings
Virtual (telehealth) or phone-based follow-up when allowed

8. TIMELINE TO LAUNCH

Phase: Business Formation and Policy Manual Development

Timeline: 1–2 months

Phase: Medicaid Enrollment and MCO Credentialing

Timeline: 60–90 days

Phase: Staff Hiring and Referral Network Setup

Timeline: 30–45 days

Phase: Program Launch and Care Plan Coordination

Timeline: Ongoing as referrals and authorizations are received

9. CONTACT INFORMATION

Kentucky Department for Medicaid Services (DMS)

Website: https://chfs.ky.gov/agencies/dms

Medicaid Provider Enrollment (MPPA): https://mppa.ky.gov

Kentucky Department for Aging and Independent Living (DAIL)

Website: https://chfs.ky.gov/agencies/dail

Kentucky Cabinet for Health and Family Services (CHFS)

Website: https://chfs.ky.gov

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

WCG supports licensed professionals, nonprofits, and human services organizations in launching conflict-free, Medicaid-compliant Case Management Services across Kentucky.

Scope of Work:

MPPA and MCO enrollment for HCBS case management
Case Management Policy & Procedure Manual development
Intake, assessment, and PCSP template creation
Staff onboarding tools and licensure compliance checklists
Quality assurance systems and monthly monitoring forms
Referral outreach materials and relationship-building strategies with MCOs, waiver teams, and hospitals