_edited.png)
CASE MANAGEMENT SERVICES PROVIDER IN UTAH
- Fatumata Kaba
- 1 day ago
- 3 min read
COORDINATING INDIVIDUALIZED SUPPORTS TO HELP PARTICIPANTS ACCESS, NAVIGATE, AND MAXIMIZE MEDICAID WAIVER SERVICES
Case Management Services in Utah ensure individuals receiving Home and Community-Based Services (HCBS) are supported with planning, coordination, advocacy, and oversight across all aspects of care. Case Managers serve as the central point of contact for individuals with disabilities and their families, helping to develop service plans, monitor outcomes, and connect participants to needed providers and community resources.
These services are authorized under Utah’s 1915(c) HCBS waiver programs, administered by the Department of Health and Human Services (DHHS), primarily through the Division of Services for People with Disabilities (DSPD).
1. GOVERNING AGENCIES
Agency: Utah Department of Health and Human Services (DHHS) – Division of Services for People with Disabilities (DSPD)
Role: Oversees case management across HCBS waivers, including training, enrollment, monitoring, and quality assurance.
Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Sets federal HCBS waiver guidelines and mandates that case management services remain conflict-free and person-centered.
2. CASE MANAGEMENT SERVICES OVERVIEW
Case Managers support individuals in gaining access to HCBS, medical, behavioral, educational, and social services. They serve as liaisons between participants, providers, and the DSPD, ensuring services are delivered in accordance with each participant’s Individual Support Plan (ISP).
Key functions include:
Conducting needs assessments and service planning
Developing, monitoring, and revising ISPs
Facilitating participant choice and self-determination
Identifying and coordinating waiver and community resources
Monitoring service quality and ensuring health and safety
Addressing barriers to service access
Ensuring documentation, billing accuracy, and compliance with waiver guidelines
Note: Utah follows CMS guidelines requiring conflict-free case management — meaning agencies that provide direct services cannot also provide case management to the same individuals.
3. LICENSING & PROVIDER APPROVAL REQUIREMENTS
Prerequisites:
Register business with the Utah Division of Corporations
Obtain EIN and Type 2 NPI
Enroll as a Utah Medicaid provider
Apply for DSPD Case Management Provider approval
Ensure compliance with Conflict-Free Case Management requirements
Maintain general liability and professional insurance
Develop a Case Management Services Policy & Procedure Manual
4. UTAH PROVIDER ENROLLMENT PROCESS
Step 1: Register entity and acquire EIN and NPI
Step 2: Enroll with Utah Medicaid as a case management provider
Step 3: Apply for DSPD case management certification and meet training prerequisites
Step 4: Submit required policies, supervision plan, and sample service documentation
Step 5: Complete MySupport and DSPD orientation
Step 6: Begin receiving case assignments and initiate ISP development
5. REQUIRED DOCUMENTATION
EIN, NPI, Articles of Incorporation
Utah Medicaid and DSPD enrollment confirmation
Conflict-Free Assurance Attestation
Case Management Services Policy Manual including:
Participant rights and person-centered planning procedures
Needs assessment protocols
ISP development, review, and revision processes
Monthly monitoring and contact log requirements
Critical incident tracking and reporting
Transition/discharge protocols
Service documentation and billing forms
Staff training and supervision documentation
6. STAFFING REQUIREMENTS
Role: Case Manager
Requirements: Bachelor’s degree in social work, psychology, nursing, or a related field; relevant experience; background check
Role: Clinical Supervisor (recommended for oversight of complex cases)
Requirements: Master's degree or licensed professional in human services or healthcare
All staff must complete:
HIPAA and confidentiality training
Abuse, Neglect, and Exploitation Prevention (ANEP)
DSPD MySupport training modules
Person-Centered Planning (PCP) training
ISP documentation and monitoring procedures
Emergency preparedness and critical incident response
7. MEDICAID WAIVER PROGRAMS
Case Management is a required and reimbursable service under:
Community Supports Waiver (CSW)
Acquired Brain Injury (ABI) Waiver
Physical Disabilities Waiver (PDW)
Medically Complex Children’s Waiver (MCCW)
New Choices Waiver (NCW) – For individuals transitioning from institutional settings
8. TIMELINE TO LAUNCH
Phase: Business Formation & Policy Development
Timeline: 1–2 months
Phase: Medicaid Enrollment & DSPD Certification
Timeline: 2–3 months
Phase: Staff Hiring & Required Training
Timeline: 30–45 days
Phase: Start of Service Delivery
Timeline: Begins upon assignment of participant cases
9. CONTACT INFORMATION
Utah Department of Health and Human Services (DHHS) – DSPD
Website: https://dspd.utah.gov
Utah Medicaid Provider Enrollment
Website: https://medicaid.utah.gov
Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov
WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — UTAH CASE MANAGEMENT PROVIDER
WCG equips new agencies with everything needed to offer high-quality, conflict-free case management services in compliance with Utah Medicaid and DSPD standards.
Scope of Work:
Medicaid and DSPD enrollment support
Conflict-Free Case Management policy framework
Case Management Services Manual and ISP templates
Staff onboarding packets and monthly monitoring logs
Quality assurance tools and incident response forms
Billing, service documentation, and audit preparation
Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.
Comments