CASE MANAGEMENT SERVICES PROVIDER IN MONTANA

SUPPORTING INDIVIDUALS THROUGH COORDINATED CARE AND SERVICE PLANNING

Case Management Services in Montana facilitate coordinated care for individuals with disabilities, chronic illnesses, or complex health needs. These services help participants access needed healthcare, social, and support services while fostering independence and well-being. Case Management is authorized under the Montana Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: Montana Department of Public Health and Human Services (DPHHS)

Role: Administers Medicaid waiver funding for Case Management Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Developmental Disabilities Program (DDP) within DPHHS

Role: Oversees service quality, participant protections, and compliance for Case Management Services under HCBS waiver programs.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring Medicaid-funded Case Management Services meet HCBS quality, person-centered planning, and participant protection standards.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management Services offer comprehensive care coordination and planning for individuals needing long-term support, helping them achieve and maintain their highest level of independence.

Approved providers may deliver:

• Service Coordination: Linking individuals to medical, behavioral, and social services.

• Care Planning: Developing and monitoring Individualized Service Plans (ISPs) to meet participants' needs and preferences.

• Resource Access: Assisting with the application process for healthcare, housing, and community resources.

• Advocacy: Ensuring individuals’ rights and preferences are respected during care planning and service delivery.

• Crisis Intervention: Coordinating immediate care and support during emergencies.

• Ongoing Monitoring: Regularly reviewing the effectiveness of services and making adjustments as needed.

All case management must be delivered according to the participant’s ISP and comply with Medicaid waiver guidelines.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register the business entity with the Montana Secretary of State.

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

• Enroll as a Medicaid Waiver Case Management provider via the Montana Medicaid Provider Enrollment Portal.

• Maintain general liability and professional liability insurance.

• Develop policies for care planning, documentation, participant rights, and emergency response.

• Ensure staff meet background checks, health screenings, and relevant training requirements.

4. MONTANA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Complete the Provider Enrollment Application through the Montana Medicaid Provider Enrollment Portal for Case Management Services under HCBS waivers.

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, staff qualifications, and service policy manuals.

Program Readiness Review:

• DPHHS reviews provider readiness, including staff qualifications, care coordination protocols, and documentation systems.

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for Case Management Services using assigned billing codes.

5. REQUIRED DOCUMENTATION

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

• IRS EIN confirmation

• NPI confirmation

• Proof of general and professional liability insurance

• Case Management Services Policy & Procedure Manual including:

  • Intake, assessment, and service planning procedures

  • Crisis intervention and emergency response protocols

  • Advocacy, resource linkage, and care coordination guidelines

  • Documentation standards, HIPAA compliance, and participant rights policies

  • Staff credentialing, background checks, and continuing education records

  • Medicaid billing procedures and audit readiness

6. STAFFING REQUIREMENTS

Role: Case Management Program Director

Requirements: Bachelor’s degree in social work, human services, or healthcare; experience in care coordination preferred; supervisory experience beneficial.

Role: Case Managers

Requirements: Bachelor’s degree in social services or related field; training in care planning, crisis intervention, and Medicaid service coordination; background clearance.

All staff must complete:

• Training in person-centered planning and service coordination

• HIPAA and confidentiality training

• Crisis management and advocacy training

• Annual continuing education and competency evaluations

7. MEDICAID WAIVER PROGRAMS

Case Management Services are available under the following Montana Medicaid Waivers:

• Comprehensive Waiver for Individuals with Developmental Disabilities

• Community Supports Waiver for Adults with Physical Disabilities

• Big Sky Waiver (Aged and Disabled)

• Traumatic Brain Injury (TBI) Waiver

• Children's Autism Waiver

Services may include:

• Service planning and coordination

• Advocacy and resource linkage

• Crisis intervention and follow-up

• Ongoing service monitoring and evaluation

8. TIMELINE TO LAUNCH

Phase: Business Formation and Compliance Preparation

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development

Timeline: 2–3 months

Phase: Montana Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing Setup and Case Management Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

Montana Department of Public Health and Human Services (DPHHS)

Website: https://dphhs.mt.gov/

Developmental Disabilities Program (DDP) — DPHHS

Website: https://dphhs.mt.gov/dsd/developmentaldisabilities

Centers for Medicare & Medicaid Services (CMS)

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

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

WCG supports agencies in launching Medicaid-compliant Case Management Services in Montana, offering:

Scope of Work:

• Business registration, Medicaid enrollment, and compliance preparation

• Policy manual development tailored to case management practices

• Staff training programs, credentialing templates, and care coordination protocols

• Medicaid billing system setup and claims management

• Website, branding, and outreach strategies

• Incident reporting, documentation standards, and quality assurance measures

• Networking strategies to connect with healthcare and community resources

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.