CASE MANAGEMENT SERVICES PROVIDER IN VIRGINIA

Fatumata Kaba
4 days ago
4 min read

COORDINATING CARE, ADVOCACY, AND ACCESS TO SERVICES FOR INDIVIDUALS WITH COMPLEX NEEDS ACROSS HOME AND COMMUNITY SETTINGS

Case Management Services in Virginia provide critical support to individuals with disabilities, chronic health conditions, or behavioral health needs by helping them navigate the system of care, develop individualized service plans, and access the right resources at the right time. Case Managers act as advocates and coordinators—connecting individuals to services while ensuring those services align with their preferences and functional needs.

These services are authorized under Medicaid through programs such as the CCC Plus Waiver, the Community Living (CL) Waiver, and the Family and Individual Supports (FIS) Waiver. Oversight is provided by the Department of Medical Assistance Services (DMAS) and coordinated through Community Services Boards (CSBs) or Managed Care Organizations (MCOs).

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1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)

Role: Defines standards for case management services, processes provider enrollment, and oversees claims.

Agency: Community Services Boards (CSBs)

Role: Oversee case management for individuals with intellectual and developmental disabilities (IDD), approve service plans, and monitor service delivery.

Agency: Managed Care Organizations (MCOs)

Role: Coordinate case management under the CCC Plus Waiver and ensure compliance with person-centered planning principles.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management includes a wide range of activities aimed at developing and maintaining an Individual Support Plan (ISP), monitoring services, and empowering individuals to live as independently as possible.

Core services include:

Person-centered assessments and planning
Identification of service needs and supports
Development and coordination of the ISP
Assistance with accessing Medicaid and non-Medicaid services
Crisis planning and referral to emergency resources
Monitoring service quality, documentation, and satisfaction
Advocacy to ensure dignity, choice, and integration

All services must follow a person-centered approach and adhere to timelines and review standards set by DMAS.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Virginia State Corporation Commission (SCC)
Obtain an EIN and Type 2 NPI
Hire or contract with Qualified Case Managers (credentials required)
Obtain affiliation with Virginia DBHDS Human Rights Office
Develop a Case Management Policy & Procedure Manual per DMAS and DBHDS standards
Enroll as a Medicaid provider through the MES portal
Contract with appropriate CSBs (CL/FIS Waivers) or MCOs (CCC Plus)

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your entity with SCC, obtain EIN and NPI

Step 2: Hire qualified staff and create policy documentation

Step 3: Enroll through DMAS MES Provider Portal

Step 4: Submit Human Rights and Licensing documentation (for CL/FIS Waivers)

Step 5: Contract with MCOs or CSBs depending on waiver type

Step 6: Launch services following ISP approval and referral

5. REQUIRED DOCUMENTATION

SCC registration, EIN, NPI
Staff credentials and background checks
Medicaid enrollment confirmation and CSB/MCO referral forms
Case Management Policy & Procedure Manual including:
- Intake, eligibility, and assessment protocols
- ISP development, updates, and review timelines
- Documentation and service tracking tools
- Crisis management and emergency protocols
- HIPAA compliance and client confidentiality
- Person-centered planning training and forms
- Client grievance procedures

6. STAFFING REQUIREMENTS

Role: Case Manager or Support Coordinator

Minimum Requirements:

Bachelor’s degree in human services or related field
One year of experience with the target population
Knowledge of Medicaid waiver programs and person-centered planning
Background check, CPR/First Aid, and DBHDS-required trainings

Role: Clinical Supervisor or Program Director (optional)

Responsibilities: Oversight of service quality, staff training, and ISP compliance

All staff must complete:

DBHDS-approved person-centered training
Human Rights and HIPAA training
Crisis de-escalation and emergency response training
Documentation and service coordination workshops

7. MEDICAID WAIVER PROGRAMS

Case Management is a required or optional component of the following:

Community Living (CL) Waiver – Support Coordination is mandatory and managed by CSBs
Family and Individual Supports (FIS) Waiver – Also managed through CSBs
CCC Plus Waiver – Case Management may be provided by MCO-contracted providers
Early Intervention and EPSDT Services – Targeted case management for children with developmental delays

All activities must be authorized through the ISP and documented according to DMAS and DBHDS protocols.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Staff Recruitment

Timeline: 2–3 weeks

Phase: Policy Manual Development & Medicaid Enrollment

Timeline: 4–6 weeks

Phase: CSB or MCO Contracting & Readiness Review

Timeline: 2–3 weeks

Phase: Launch of Services

Timeline: Begins after referral and service authorization

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)