CASE MANAGEMENT SERVICES PROVIDER IN TEXAS

Fatumata Kaba
2 days ago
3 min read

COORDINATING CARE, RESOURCES, AND SUPPORTS TO PROMOTE INDEPENDENT LIVING FOR MEDICAID WAIVER PARTICIPANTS ACROSS TEXAS

Case Management (also known as Service Coordination) is a critical support under Texas Medicaid waiver programs. It ensures that individuals with disabilities, chronic conditions, or complex needs receive coordinated, person-centered services in the most integrated settings. These services are available under various 1915(c) Home and Community-Based Services (HCBS) Waivers, including HCS, CLASS, DBMD, TxHmL, and MDCP.

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1. GOVERNING AGENCIES

Agency: Texas Health and Human Services Commission (HHSC)

Role: Administers Medicaid waiver programs and contracts with providers for case management services.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Ensures Texas waiver programs follow federal guidelines for conflict-free case management, service coordination, and participant rights.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management Services involve assessment, service planning, coordination, monitoring, and advocacy to help individuals access needed Medicaid services, natural supports, and community resources.

Key activities include:

Conducting assessments and reassessments
Developing or updating the Individual Plan of Care (IPC) or Person-Directed Plan (PDP)
Coordinating waiver and non-waiver services (housing, employment, medical, behavioral)
Monitoring health, safety, and satisfaction through regular contact
Responding to crises or service interruptions
Supporting transitions (school to adult services, hospital to home, etc.)
Maintaining documentation for compliance and audits

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Texas Secretary of State
Obtain EIN and Type 2 NPI
Enroll as a Medicaid waiver provider through TMHP (Texas Medicaid & Healthcare Partnership)
Apply for contract approval through HHSC for the desired waiver programs
Demonstrate conflict-free status (you may not provide both case management and direct services to the same client)
Maintain liability insurance
Develop a Case Management Policy & Procedure Manual

4. TEXAS PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN/NPI

Step 2: Enroll with TMHP as a Medicaid provider

Step 3: Submit a provider application to HHSC under your chosen waiver program(s)

Step 4: Provide policy manuals, training plans, and documentation tools

Step 5: Complete HHSC readiness review and begin accepting participant assignments

5. REQUIRED DOCUMENTATION

Business registration, EIN, NPI confirmation
TMHP Medicaid enrollment and HHSC contract
Liability insurance and conflict-free provider documentation
Case Management Policy & Procedure Manual including:
- Person-centered assessment and planning protocols
- Contact schedule (home visits, calls, monitoring requirements)
- Risk identification and crisis planning
- Service authorization coordination
- Incident reporting and participant rights documentation
- Quality assurance procedures and audit readiness
- HIPAA compliance and records retention guidelines

6. STAFFING REQUIREMENTS

Role: Case Manager / Service Coordinator

Requirements: Bachelor’s degree in social work, psychology, health, or human services field; experience with disability services or care coordination preferred

Role: Clinical Supervisor (if required for specific waivers)

Requirements: Advanced licensure (e.g., LMSW, LPC) may be needed for oversight

All staff must complete:

HHSC waiver program training
Person-centered planning and Medicaid documentation training
HIPAA, rights protections, and abuse prevention
Emergency planning and risk mitigation
Ongoing training in quality monitoring and outcomes tracking

7. MEDICAID WAIVER PROGRAMS

Case Management Services are included under:

CLASS (Community Living Assistance & Support Services)
HCS (Home and Community-Based Services)
TxHmL (Texas Home Living)
DBMD (Deaf Blind with Multiple Disabilities)
MDCP (Medically Dependent Children Program)
YES Waiver (Youth Empowerment Services) – Behavioral health coordination for children