CASE MANAGEMENT SERVICES PROVIDER IN LOUISIANA

Fatumata Kaba
Aug 12
4 min read

COORDINATING CARE, SERVICES, AND SUPPORT SYSTEMS TO PROMOTE WELL-BEING AND COMMUNITY LIVING

Case Management Services in Louisiana help individuals enrolled in Medicaid and waiver programs access the care and resources they need to live independently. Case managers work directly with participants, families, providers, and state agencies to assess needs, develop individualized care plans, and coordinate service delivery across health, behavioral, and social domains.

1. GOVERNING AGENCIES

Agency: Louisiana Department of Health (LDH) — Office of Aging and Adult Services (OAAS) & Office for Citizens with Developmental Disabilities (OCDD)

Role: Oversees waiver case management guidelines, assigns support coordination agencies, and ensures compliance with person-centered planning

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight and ensures case management complies with 1915(c) waiver and person-centered service planning requirements

Agency: Medicaid Management Information System (MMIS) / Molina Medicaid Solutions

Role: Manages enrollment and reimbursement for case management billing

Agency: Managed Care Organizations (MCOs) under Bayou Health

Role: Coordinate with case managers for referrals, authorizations, and data reporting (in specific programs)

2. CASE MANAGEMENT SERVICE OVERVIEW

Case Management (also called Support Coordination) is a comprehensive, person-centered service that includes:

Functional needs assessments and goal setting
Individualized Service Plan (ISP) or Plan of Care (POC) development
Referral to home and community-based services (HCBS)
Coordination with physicians, therapists, and providers
Monitoring of service delivery and participant satisfaction
Critical incident reporting and service plan revision
Advocacy and assistance with transitions (e.g., institutional discharge)

Approved providers support participants in:

Residential Options Waiver (ROW)
Supports Waiver
New Opportunities Waiver (NOW)
Children’s Choice Waiver
Community Choices Waiver (limited case management components)
EPSDT and transition support (for youth aging out of services)

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Louisiana Secretary of State
Obtain IRS EIN and Type 2 NPI
Enroll with Medicaid as a Case Management or Support Coordination provider via the Louisiana Medicaid Provider Enrollment Portal
Apply for waiver-specific designation with LDH (OAAS or OCDD)
Maintain general liability and professional insurance
Employ qualified case managers (e.g., social workers, counselors, or human services staff with experience)
Develop a Case Management Services Policy & Procedure Manual
Ensure HIPAA-compliant documentation and coordination systems

4. PROVIDER ENROLLMENT PROCESS

Step 1: Business and Medicaid Enrollment

Apply through https://www.lamedicaid.com
Submit business documents, staffing plan, and organizational structure

Step 2: Waiver-Specific Approval

Submit an application to LDH OAAS or OCDD to become an approved support coordination agency
Complete background checks, staff credentialing, and service protocols

Step 3: Staff Training and Manual Development

Train staff on person-centered planning, critical incident protocols, and waiver service standards
Implement care planning and documentation tools

Step 4: Referrals and Service Delivery

Receive participant assignments from LDH or MCOs
Begin assessments, service planning, and documentation per waiver rules

5. REQUIRED DOCUMENTATION

Articles of Incorporation or sole proprietorship filing
IRS EIN and NPI documentation
LDH case management designation or waiver program approval
Certificates of insurance
Case Management Services Policy & Procedure Manual, including:
- Intake and person-centered planning templates
- ISP/POC development forms and service tracking logs
- Referral logs and interdisciplinary team coordination forms
- Critical incident and grievance reporting policies
- Participant rights and informed consent forms
- Monthly monitoring and reassessment schedules
- Documentation, quality assurance, and billing templates

6. STAFFING REQUIREMENTS

Role: Case Manager / Support Coordinator

Requirements: Bachelor’s degree in social work, psychology, or a related field; 1–2 years’ experience with individuals with disabilities or aging adults; background check clearance

Role: Clinical Supervisor (required for agency model)

Requirements: Licensed social worker or mental health professional; responsible for supervision, service review, and compliance

Training Requirements for All Staff:

HIPAA and participant confidentiality
Person-Centered Planning and waiver rules
Abuse/neglect reporting and incident protocols
Cultural competency and disability rights
Medicaid billing documentation and audit readiness

7. MEDICAID WAIVER & TRANSITION SERVICES

Case Management Services are authorized and reimbursed under:

Residential Options Waiver (ROW)
Supports Waiver
Children’s Choice Waiver
New Opportunities Waiver (NOW)
Community Choices Waiver (limited case management functions)
EPSDT and Money Follows the Person (MFP) transition supports

Approved providers may deliver:

In-home assessments and service coordination
Ongoing case monitoring and documentation
Plan updates and annual reassessments
Coordination of transportation, therapy, home modifications, or direct care services
Transition assistance from institutional care to home/community settings