CASE MANAGEMENT SERVICES PROVIDER IN NEW YORK

Fatumata Kaba
Sep 4
4 min read

COORDINATING CARE AND SUPPORT FOR INDIVIDUALS IN HOME AND COMMUNITY SETTINGS

Case Management Services in New York assist individuals with disabilities, chronic conditions, or age-related challenges by coordinating care, advocating for services, and facilitating access to community resources. These services ensure comprehensive, person-centered care while promoting independence and well-being. Case Management Services are authorized under New York Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: New York State Department of Health (NYSDOH)

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

Agency: Office for People With Developmental Disabilities (OPWDD)

Role: Provides oversight for services targeting individuals with developmental disabilities.

Agency: New York State Office of Mental Health (OMH)

Role: Monitors behavioral health and mental health services.

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 involve assessment, planning, coordination, and monitoring to ensure individuals receive appropriate care and support in their community.

Approved providers may deliver:

Comprehensive Assessment: Evaluating individual needs, preferences, and available supports.
Care Planning: Developing personalized service plans in collaboration with participants and families.
Resource Coordination: Connecting individuals with community services and supports.
Service Monitoring: Tracking the effectiveness of care plans and making adjustments as needed.
Crisis Intervention: Providing immediate support during emergencies or changes in health status.
Advocacy: Ensuring that individuals receive necessary services and support.
Referral Services: Linking to healthcare providers, behavioral health services, and community resources.
Documentation and Reporting: Maintaining accurate records of care coordination and outcomes.
Care Transitions Support: Facilitating smooth transitions from hospitals or other care settings back to the community.

All services are delivered according to the Individualized Service Plan (ISP) to meet the participant’s specific needs and support goals.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register the business entity with the New York Department of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Case Management provider via the New York Medicaid Provider Enrollment Portal (eMedNY).
Maintain general liability and professional liability insurance.
Develop policies for case management, service coordination, and client advocacy.
Ensure staff meet background checks, health screenings, and case management training requirements.

4. NEW YORK PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Complete the Provider Enrollment Application through the eMedNY Portal for Case Management Services under HCBS waivers.

Application and Documentation Submission:

Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, case management training documentation, and policy manuals.

Program Readiness Review:

NYSDOH, OPWDD, and OMH evaluate provider readiness, including client assessment procedures, documentation standards, and staff qualifications.

Approval & Medicaid Enrollment:

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

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (New York Department of State)
IRS EIN confirmation
NPI confirmation
Proof of general and professional liability insurance
Case Management Services Policy & Procedure Manual including:
- Intake, assessment, and individualized care planning procedures
- Service coordination, advocacy, and referral guidelines
- Staff credentialing, background checks, and ongoing training records
- Documentation standards for care tracking and Medicaid billing
- HIPAA compliance, participant rights, and grievance handling
- Emergency response, crisis management, and safety protocols
- Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Case Management Program Director

Requirements: Bachelor’s or Master’s degree in social work, human services, or healthcare administration; experience in case management and supervision.

Role: Case Managers

Requirements: Bachelor’s degree in social work, psychology, or a related field; case management certification preferred; experience with client advocacy; background clearance.

Role: Support Coordinators

Requirements: Experience in care coordination and client engagement; knowledge of community resources; background clearance.

All staff must complete: