CASE MANAGEMENT SERVICES PROVIDER IN OREGON

Fatumata Kaba
Oct 6
4 min read

COORDINATING INDIVIDUALIZED SUPPORTS TO HELP OREGONIANS NAVIGATE MEDICAID WAIVER SERVICES AND ACHIEVE THEIR PERSONAL GOALS

Case Management Services in Oregon are Medicaid-funded supports that assist individuals with disabilities, chronic conditions, and aging-related needs in accessing, coordinating, and monitoring their Home and Community-Based Services (HCBS). Case managers play a central role in person-centered planning, service referrals, and ensuring that individuals receive the right care at the right time. These services are integral to Oregon’s Medicaid programs — including the Oregon Health Plan (OHP), the K Plan, and various HCBS Waivers.

1. GOVERNING AGENCIES

Agency: Oregon Department of Human Services (ODHS) – Aging and People with Disabilities (APD), Developmental Disabilities Services (DDS)

Role: Authorizes and oversees Medicaid case management functions through Area Agencies on Aging (AAAs), Community Developmental Disabilities Programs (CDDPs), and brokerages.

Agency: Oregon Health Authority (OHA)

Role: Administers Medicaid enrollment, quality monitoring, and care coordination systems through the Oregon Health Plan (OHP).

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight of case management services under 1915(c) and 1915(k) authorities.

Agency: Oregon Secretary of State (SOS)

Role: Handles legal registration for case management provider entities.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management helps individuals understand their options, access services, and remain safely supported at home or in the community. Services are person-centered and include ongoing communication with providers, families, and care teams.

Approved providers may deliver:

Assessment & Eligibility Determination: Functional needs assessments, documentation, and service planning.
Individual Support Plan (ISP) Development: Creating and updating person-centered service plans.
Service Authorization & Referral: Connecting individuals to HCBS providers and ensuring authorizations are in place.
Monitoring & Follow-Up: Ongoing contact with the participant to ensure service effectiveness and safety.
Crisis Planning & Problem-Solving: Responding to urgent needs and coordinating temporary interventions.
Record-Keeping & Reporting: Case notes, progress updates, and Medicaid documentation.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Oregon Secretary of State.
Obtain EIN from the IRS and a Type 2 NPI.
Enroll as a Medicaid provider through the Oregon Health Plan Provider Portal.
Apply for certification as a case management entity through ODHS (required for operating as a CDDP, brokerage, or contracted entity).
Carry professional liability and workers’ compensation insurance.
Develop a Case Management Policy & Procedure Manual in alignment with Oregon Administrative Rules (OARs) and CMS guidance.

4. OREGON PROVIDER ENROLLMENT PROCESS

Step 1: Register your business and acquire EIN, NPI, and insurance.Step 2: Enroll as a Medicaid provider through OHA’s Provider Portal.Step 3: Submit an application for ODHS/DD or APD case management certification (depending on population served).Step 4: Provide resumes, credentials, and training records for qualified staff.Step 5: After approval, begin receiving referrals or entering into service coordination contracts.

5. REQUIRED DOCUMENTATION

Articles of Incorporation and business registration
EIN and NPI confirmations
Insurance certificates (liability and workers’ comp)
Case Management Policy & Procedure Manual, including:
- Assessment protocols and eligibility verification
- ISP development workflows
- Referral and authorization tracking
- Risk mitigation and emergency protocols
- Participant rights and consent procedures
- Documentation standards and progress note templates
- Incident reporting and grievance resolution
- Quality assurance and utilization review policies

6. STAFFING REQUIREMENTS

Role: Case Manager / Service Coordinator

Requirements: Bachelor’s degree in social work, human services, or related field; experience with Medicaid programs and person-centered planning; background check.

Role: Program Supervisor / Quality Coordinator

Requirements: Oversees caseload distribution, documentation quality, and training; often holds an advanced degree or clinical license.

Role: Administrative Support (optional)

Requirements: Manages intake paperwork, records management, and communication logs.

All staff must complete:

ODHS-required core training
HIPAA and participant confidentiality training
Person-centered planning and documentation procedures
Mandatory reporter and abuse prevention training
Annual training updates and supervisory evaluations

7. MEDICAID WAIVER PROGRAMS

Case Management Services are authorized through:

K Plan (1915(k)): Ongoing case management for individuals with significant functional needs.
Comprehensive & Support Services Waivers (IDD): Includes ISP planning, service monitoring, and outcomes tracking.
APD HCBS Waivers: For older adults and people with physical disabilities needing coordinated in-home support.
Children’s DD Waiver: Case coordination for children with intellectual and developmental disabilities.
Money Follows the Person (MFP): Transition case management for individuals leaving nursing facilities.