CASE MANAGEMENT SERVICES PROVIDER IN OKLAHOMA

Fatumata Kaba
Sep 8
4 min read

COORDINATING PERSONALIZED SUPPORTS TO HELP OKLAHOMANS NAVIGATE MEDICAID WAIVERS, COMMUNITY RESOURCES, AND DAILY NEEDS

Case Management Services in Oklahoma help individuals with disabilities, chronic health conditions, or aging-related challenges access and manage the supports they need to live safely and independently in their communities. Case managers coordinate care, advocate for participants, and connect them with Medicaid-funded services and local resources. These services are authorized under Oklahoma Medicaid Home and Community-Based Services (HCBS) Waivers, including the ADvantage Waiver and Developmental Disabilities Services (DDS) programs.

1. GOVERNING AGENCIES

Agency: Oklahoma Health Care Authority (OHCA)

Role: Administers Medicaid funding (SoonerCare), oversees provider enrollment, and manages billing policies.

Agency: Oklahoma Department of Human Services (OKDHS) – Aging Services and DDS

Role: Certifies case management providers, assigns caseloads, and provides oversight of care coordination.

Agency: Centers for Medicare & Medicaid Services (CMS)**

Role: Ensures that Case Management Services meet federal HCBS standards for person-centered planning and service access.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management Services assist individuals in developing and implementing a service plan that meets their medical, functional, and social needs.

Approved providers may deliver:

Comprehensive Needs Assessments: Identifying the participant’s strengths, risks, preferences, and support needs.
Service Planning: Developing and maintaining an individualized service plan (ISP) based on participant goals.
Provider Coordination: Connecting participants to approved waiver and community providers.
Crisis Management & Advocacy: Responding to changes in condition or urgent needs and advocating for appropriate supports.
Monitoring & Follow-Up: Reviewing ISP implementation and service quality at regular intervals.
Eligibility & Enrollment Assistance: Supporting individuals through SoonerCare and waiver program eligibility processes.
Referral to Community Resources: Connecting individuals to housing, food assistance, transportation, and employment programs.
Documentation: Progress notes, reassessment records, service tracking logs, and SoonerCare billing documentation.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Oklahoma Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Apply for certification through OKDHS (DDS or Aging Services, depending on target population).
Enroll with OHCA through the SoonerCare Provider Portal.
Maintain professional liability insurance.
Develop a Case Management Policy & Procedure Manual.
Ensure staff meet educational, licensing, and training requirements established by OKDHS.

4. OKLAHOMA PROVIDER ENROLLMENT PROCESS

Step 1: Legal Formation & Policy Development

Form a legal entity, gather insurance, and prepare service protocols.

Step 2: Certification Application (DDS or ADvantage)

Submit documentation to OKDHS, including staff credentials, training logs, and sample service plans.

Step 3: SoonerCare Enrollment via OHCA

Apply as a case management provider and link your credentials to the applicable waiver program.

Step 4: Staff Approval & Caseload Assignment

Once approved, providers may receive referrals or caseloads based on waiver program needs.

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License
IRS EIN and NPI confirmation
General and professional liability insurance
Case Management Services Policy & Procedure Manual, including:
- Intake, assessment, and care planning procedures
- Participant advocacy and provider coordination workflows
- Reassessment and monitoring protocols
- Participant rights and HIPAA compliance policies
- Emergency response and documentation tracking templates
- Quality assurance plans and satisfaction surveys
- Medicaid billing logs and audit preparation tools

6. STAFFING REQUIREMENTS

Role: Case Management Program Administrator

Requirements: Bachelor’s or Master’s degree in social work, public health, or related field; experience supervising case management services.

Role: Case Managers

Requirements:

Bachelor’s degree in social work, psychology, nursing, or human services
Must complete OKDHS/ADvantage/DDS-specific case management training
CPR/First Aid certification and background check required

All staff must complete:

Person-centered planning and care coordination training
HIPAA and participant rights education
Annual continuing education and performance evaluations
Crisis response and documentation protocol training

7. MEDICAID WAIVER PROGRAMS

Case Management Services are available under:

ADvantage Waiver – for aging adults and adults with physical disabilities
Medically Fragile Waiver
Community Waiver – for individuals with IDD requiring full-time supports
In-Home Supports Waiver (Adult and Child) – includes limited case management
Living Choice Program – transitional case management for those moving out of institutions
State Plan SoonerCare Case Management – for specific high-need populations (e.g., children with complex health needs)