CASE MANAGEMENT SERVICES PROVIDER IN TENNESSEE

Fatumata Kaba
3 days ago
3 min read

EMPOWERING PARTICIPANTS WITH INTELLECTUAL, DEVELOPMENTAL, AND MEDICAL NEEDS THROUGH PERSONALIZED COORDINATION OF SERVICES, RESOURCES, AND SUPPORT SYSTEMS

Case Management Services in Tennessee are essential for helping Medicaid waiver participants access the care, services, and supports they need to thrive in the community. Case managers act as advocates and service coordinators, ensuring the participant’s needs are met through proper planning, monitoring, and collaboration. These services are reimbursed under TennCare, Employment and Community First (ECF) CHOICES, and 1915(c) HCBS Waiver Programs.

1. GOVERNING AGENCIES

Agency: TennCare (Tennessee Medicaid)

Role: Oversees the reimbursement and performance standards for case management activities.

Agency: Department of Intellectual and Developmental Disabilities (DIDD)

Role: Approves and monitors Support Coordinators and Case Management agencies under waiver programs like ECF CHOICES and 1915(c).

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

Role: Sets federal regulations for conflict-free case management, care coordination, and participant rights in HCBS programs.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management (also referred to as Support Coordination) involves assessing, planning, coordinating, monitoring, and advocating for an individual's services and supports across medical, behavioral, and social needs.

Core functions include:

Comprehensive needs assessments
Development and maintenance of Individual Support Plans (ISP)
Monitoring of service delivery and participant satisfaction
Crisis and incident response coordination
Transition planning (e.g., from school, hospital, or institutional settings)
Resource linkage (housing, employment, therapy, transportation)
Documentation and compliance reporting

All services must be person-centered, outcome-driven, and aligned with Medicaid standards for conflict-free case management.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Tennessee Secretary of State
Obtain EIN and Type 2 NPI
Enroll with TennCare and/or DIDD as a case management or support coordination provider
Ensure conflict-free status (i.e., not delivering direct HCBS services to the same individual)
Maintain liability insurance and data security protocols
Develop a Case Management Services Policy & Procedure Manual

4. TENNESSEE PROVIDER ENROLLMENT PROCESS

Step 1: Form a legal entity and obtain EIN/NPI

Step 2: Apply for certification with DIDD or TennCare, depending on the target population

Step 3: Submit documentation for key staff (e.g., resumes, licensure, background checks)

Step 4: Demonstrate the system for ISP development, tracking, and reporting

Step 5: Complete any required training and begin receiving participant referrals

5. REQUIRED DOCUMENTATION

Business registration, EIN, NPI
Staff credentials, degrees, background checks, CPR/First Aid
Liability insurance and HIPAA compliance policies
Case Management Policy & Procedure Manual, including:
- Assessment tools and eligibility documentation
- ISP template and planning protocols
- Crisis planning and risk mitigation
- Participant rights, grievance procedures, and informed consent
- Incident reporting and quality improvement
- Progress notes, monitoring forms, and visit logs

6. STAFFING REQUIREMENTS

Role: Case Manager / Support Coordinator

Requirements: Bachelor’s or master’s degree in social work, psychology, or related field; experience with HCBS or behavioral health preferred

Role: Clinical Supervisor (optional but recommended)

Requirements: Master’s-level credential (LCSW, LPC, etc.); provides guidance and plan oversight

All staff must complete:

DIDD or MCO-approved case management training
ISP development and HCBS documentation training
HIPAA, person-centered planning, and abuse prevention
Incident management and emergency response training
Annual competency assessments and quality reviews

7. MEDICAID WAIVER PROGRAMS

Case Management Services are funded under:

ECF CHOICES – For individuals with I/DD needing person-centered service coordination
1915(c) Waivers – For individuals requiring targeted case management as part of their home and community-based services
Katie Beckett Program – Coordination for children with medical complexity
TennCare MCOs – May also offer medical case management services under State Plan benefits

8. TIMELINE TO LAUNCH

Phase: Business Formation & Manual Development

Timeline: 1–2 months

Phase: Provider Enrollment & Training

Timeline: 2–3 months

Phase: Staff Onboarding & Compliance Readiness

Timeline: 30–60 days

Phase: Participant Assignment & Service Start

Timeline: Upon ISP approval and DIDD/MCO authorization

9. CONTACT INFORMATION

TennCare (Tennessee Medicaid Program)

Website: https://www.tn.gov/tenncare