CASE MANAGEMENT SERVICES PROVIDER IN SOUTH CAROLINA

Fatumata Kaba
Oct 13
3 min read

COORDINATING CARE, ADVOCATING FOR NEEDS, AND FACILITATING SERVICES TO IMPROVE QUALITY OF LIFE FOR MEDICAID WAIVER PARTICIPANTS

Case Management Services in South Carolina help Medicaid beneficiaries navigate healthcare, behavioral, and community-based services by coordinating their care through person-centered planning. These services are authorized under Home and Community-Based Services (HCBS) Waivers and administered by the South Carolina Department of Health and Human Services (SCDHHS) and the Department of Disabilities and Special Needs (DDSN). Case Managers play a critical role in ensuring that waiver participants receive timely, appropriate, and individualized support.

1. GOVERNING AGENCIES

Agency: South Carolina Department of Health and Human Services (SCDHHS)

Role: Manages Medicaid Waivers, defines case management qualifications, and reimburses enrolled providers.

Agency: South Carolina Department of Disabilities and Special Needs (DDSN)

Role: Oversees Service Coordination for individuals with intellectual and developmental disabilities (IDD), including monitoring of plan implementation and service quality.

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

Role: Sets federal guidelines ensuring conflict-free case management and participant-directed planning under Medicaid.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management (also known as Service Coordination or Support Coordination) involves assessment, planning, service linkage, monitoring, and advocacy.

Approved providers may deliver:

Comprehensive Needs Assessment: Evaluate participant strengths, preferences, and medical, behavioral, and social needs.
Person-Centered Service Planning: Create and maintain individualized service plans (ISPs) with participant and caregiver input.
Service Referral and Linkage: Coordinate with Medicaid and non-Medicaid providers to access needed supports.
Monitoring & Reassessment: Ensure that services are delivered appropriately, goals are met, and changes are made as needed.
Crisis Support & Advocacy: Address urgent issues and represent participant needs across care teams.
Documentation: Maintain service notes, contact logs, plan updates, and billing documentation.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the South Carolina Secretary of State.
Obtain EIN and Type 2 NPI.
Employ or contract with qualified Case Managers (see Staffing).
Enroll with SCDHHS or DDSN as a Medicaid provider for Case Management or Support Coordination.
Develop a Case Management Services Policy & Procedure Manual covering planning, communication, compliance, and documentation protocols.

4. SOUTH CAROLINA PROVIDER ENROLLMENT PROCESS

Step 1: Form your organization and acquire EIN, NPI, and liability insurance.

Step 2: Apply through the DDSN Provider Portal (for IDD populations) or SCDHHS portal (for other waiver populations).

Step 3: Submit staff qualifications, policy manual, and sample service plans for review.

Step 4: Complete readiness review and secure provider number.

Step 5: Begin receiving referrals and authorizations from waiver program leads.

5. REQUIRED DOCUMENTATION

Articles of Incorporation, EIN, and NPI confirmation
Professional liability and general insurance
Medicaid enrollment approval
DDSN provider certification (if applicable)
Case Management Services Policy & Procedure Manual including:
- Intake and assessment forms
- Service planning and reassessment protocols
- Documentation and contact log templates
- HIPAA and participant rights guidelines
- Critical incident reporting and follow-up
- Conflict-free case management policies
- Medicaid billing standards and audit checklists

6. STAFFING REQUIREMENTS

Role: Case Manager / Service Coordinator

Requirements:

Bachelor’s degree in a human services field (e.g., social work, psychology, counseling, education).
Experience working with Medicaid-eligible populations (IDD, aging, behavioral health).
Must pass background checks and complete DDSN or SCDHHS-approved training.

Role: Clinical Supervisor (optional but recommended)

Requirements: Oversees quality assurance, provides supervision, and ensures compliance with case management guidelines.

All staff must complete:

HIPAA and confidentiality training
Abuse prevention and critical incident reporting
Person-centered planning training
Medicaid documentation and billing training
Ongoing continuing education and competency checks

7. MEDICAID WAIVER PROGRAMS

Case Management Services are authorized through:

ID/RD Waiver – Support Coordination for individuals with intellectual/developmental disabilities
HASCI Waiver – Service Coordination for individuals with traumatic brain and spinal cord injuries
Community Supports Waiver – Case management for individuals needing less intensive support
CLTC (Community Long Term Care) – Case Management for aging and disabled adults
EPSDT / TEFRA (under 21) – Care coordination for medically complex children
PACE and MCO programs – Include case management functions under state-managed care