CASE MANAGEMENT SERVICES PROVIDER IN WASHINGTON

Fatumata Kaba
4 hours ago
3 min read

COORDINATING INDIVIDUALIZED SERVICES, ADVOCACY, AND SUPPORT TO PROMOTE HEALTH, SAFETY, AND COMMUNITY LIVING

Case Management Services in Washington provide ongoing coordination, planning, and monitoring of services for individuals with disabilities, chronic conditions, or complex needs. Case managers act as the central point of contact for Medicaid waiver participants, Apple Health members, and long-term services and supports (LTSS) recipients, ensuring that individuals receive appropriate care and achieve their person-centered goals.

Case Management is delivered under Home and Community-Based Services (HCBS) waivers administered by the Developmental Disabilities Administration (DDA) and Aging and Long-Term Support Administration (ALTSA), and reimbursed by Medicaid through the Health Care Authority (HCA).

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1. GOVERNING AGENCIES

Agency: Developmental Disabilities Administration (DDA)

Role: Oversees case management for individuals enrolled in DDA HCBS waivers (e.g., Basic Plus, Core, IFS).

Agency: Aging and Long-Term Support Administration (ALTSA)

Role: Administers case management for elderly or physically disabled adults in COPES, MAC, or CFC programs.

Agency: Health Care Authority (HCA)

Role: Administers Apple Health Medicaid and manages reimbursement via ProviderOne.

2. CASE MANAGEMENT SERVICES OVERVIEW

Core responsibilities include:

Initial and ongoing assessments to determine support needs
Development and monitoring of the Person-Centered Service Plan (PCSP)
Service coordination and referrals to healthcare, behavioral health, housing, and waiver supports
Advocacy on behalf of the individual and family
Crisis planning and risk management
Quality assurance and follow-up
Documentation of services and outcomes

Services must align with WAC 388-825, WAC 388-106, or DDA policy, depending on the waiver.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Washington Secretary of State
Obtain an EIN and Type 2 NPI
Apply with DDA or ALTSA as a Qualified Case Management Agency
Enroll with ProviderOne to bill Medicaid
Hire or contract qualified case managers with the required credentials
Submit a Policy & Procedure Manual for Case Management Services
Complete staff training in person-centered planning, HIPAA, and abuse prevention

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN, and NPI

Step 2: Submit the Case Management agency application to DDA or ALTSA

Step 3: Enroll in ProviderOne with the appropriate taxonomy code

Step 4: Develop and submit a compliant Case Management P&P Manual

Step 5: Ensure staff meet education and experience requirements

Step 6: Begin receiving referrals from state case managers upon approval

5. REQUIRED DOCUMENTATION

Medicaid enrollment confirmation via ProviderOne
Case Management contract with DDA or ALTSA
Policy & Procedure Manual, including:
- Intake and service authorization workflows
- PCSP development and review process
- Crisis response and reporting
- Confidentiality, HIPAA, and data protection
- Cultural competency and equitable service delivery
- Monthly monitoring logs and contact documentation
- Staff credentials, supervision, and continuing education logs
- Client rights and grievance procedures

6. STAFFING REQUIREMENTS

Role: Case Manager / Service Coordinator

Requirements:

Bachelor’s degree in social work, human services, or related field
At least one year of experience working with individuals with disabilities or aging adults
Knowledge of Medicaid, HCBS, and person-centered practices
Completion of DDA or ALTSA case manager training modules

Role: Program Supervisor / Lead Case Manager

Responsibilities: Reviews documentation, ensures compliance, and provides oversight

All staff must complete:

HIPAA and client rights training
Abuse prevention and mandatory reporting
Person-Centered Service Plan development training
Annual performance and documentation reviews

7. MEDICAID PROGRAMS THAT INCLUDE CASE MANAGEMENT

Basic Plus, Core, and IFS Waivers (DDA) – Ongoing case management required
COPES and CFC (ALTSA) – Case management provided by care coordinators or contracted agencies
Medicaid Alternative Care (MAC) – Supports unpaid caregivers with coordination
Apple Health (MCOs) – Care coordination may be integrated into health plan services

8. TIMELINE TO LAUNCH

Phase: Business Formation & Credential Setup

Timeline: 2–4 weeks

Phase: DDA/ALTSA Application & ProviderOne Enrollment

Timeline: 1–2 months

Phase: Staff Hiring, P&P Manual Development, Training

Timeline: 30–60 days

Phase: Begin Receiving Referrals

Timeline: Upon agency approval and contract execution

9. CONTACT INFORMATION

Developmental Disabilities Administration (DDA)

Website: https://www.dshs.wa.gov/dda

Aging and Long-Term Support Administration (ALTSA)

Website: https://www.dshs.wa.gov/altsa

Health Care Authority (HCA)

Website: https://www.hca.wa.gov

ProviderOne Enrollment Portal

Website: https://www.waproviderone.org

CASE MANAGEMENT SERVICES PROVIDER IN WASHINGTON

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — WASHINGTON CASE MANAGEMENT PROVIDER

WCG helps professionals and organizations launch Medicaid-eligible case management agencies, with full compliance support for HCBS waiver participation.

Scope of Work: