CASE MANAGEMENT SERVICES PROVIDER IN WISCONSIN

Fatumata Kaba
5 days ago
4 min read

COORDINATING PERSON-CENTERED SUPPORTS TO PROMOTE HEALTH, INDEPENDENCE, AND SERVICE ACCESS FOR INDIVIDUALS ACROSS WAIVER PROGRAMS

Case Management Services in Wisconsin help individuals with disabilities, mental health conditions, chronic illnesses, or age-related needs access, coordinate, and monitor the services and supports outlined in their care plans. These services ensure continuity, reduce gaps in care, and advocate for the individual’s goals within Wisconsin’s long-term care system. Case Management is covered under Wisconsin Medicaid’s Home and Community-Based Services (HCBS) Waivers—including IRIS (in limited circumstances), Family Care, Partnership, and the Children’s Long-Term Support (CLTS) Waiver. Case managers play a crucial role in promoting self-determination, health outcomes, and service quality.

https://video.wixstatic.com/video/dcc8e4_0ba5461d54bb46c89e7f5c0c33e54b17/1080p/mp4/file.mp4

1. GOVERNING AGENCIES

Agency: Wisconsin Department of Health Services (DHS)

Role: Establishes qualifications, scope, and monitoring standards for waiver-funded case management services.

Agency: ForwardHealth

Role: Processes Medicaid provider enrollment and reimbursement for case management services (especially under CLTS or Legacy waivers).

Agency: Managed Care Organizations (MCOs) / IRIS Consultant Agencies

Role: Deliver or oversee case management through assigned care teams (Family Care and IRIS Consultant Agencies manage internal coordination functions).

Agency: County Human Services Agencies

Role: Often contract or directly employ case managers for CLTS and legacy waiver programs.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management involves the development, implementation, coordination, and ongoing monitoring of individualized care plans to meet a participant’s needs and goals.

Core functions include:

Conducting initial and ongoing assessments
Creating or updating Individualized Service Plans (ISPs)
Coordinating formal services and informal supports
Referring individuals to community resources
Monitoring service delivery and addressing concerns
Supporting self-direction, advocacy, and goal attainment
Crisis planning and risk management
Documentation, reporting, and compliance tracking

All services must be individualized, reflect the person’s preferences, and be reviewed regularly.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Wisconsin Department of Financial Institutions (DFI)
Obtain a Federal EIN and Type 2 NPI
Enroll with ForwardHealth and/or apply to county or MCO contracts (depending on the program)
Employ or contract qualified case managers
Develop a Case Management Services Policy & Procedure Manual
Carry liability insurance and establish documentation protocols
Perform background checks and ensure HIPAA compliance

Case managers must meet minimum education and experience requirements set by the program (usually a Bachelor’s in human services or a related field).

4. WISCONSIN PROVIDER ENROLLMENT PROCESS

Step 1: Register your business and obtain an EIN/NPI

Step 2: Apply to ForwardHealth and/or county/MCO networks

Step 3: Submit your Case Management P&P Manual and resumes of qualified staff

Step 4: Complete any required state or program-specific training

Step 5: Enter into provider agreements or service contracts (especially for CLTS or county-based waivers)

Step 6: Begin service delivery upon participant plan approval

5. REQUIRED DOCUMENTATION

ForwardHealth enrollment and/or provider contracts
Case Management Services Policy & Procedure Manual including:
- Assessment and reassessment protocols
- ISP development and approval procedures
- Coordination and referral tracking
- Service delivery monitoring tools
- Participant rights and grievance procedures
- HIPAA, confidentiality, and record retention policies
- Crisis response and safety planning
- Staff credentialing, supervision, and caseload guidelines
Templates for service notes, ISP revisions, and monitoring checklists

6. STAFFING REQUIREMENTS

Role: Case Manager / Support and Service Coordinator (SSC)

Requirements:

Bachelor’s degree in social work, psychology, nursing, or a related human services field
1–2 years of experience in long-term care or service coordination preferred
Familiarity with Medicaid waivers and person-centered planning
Background check clearance
HIPAA, abuse prevention, and documentation training

All case managers must complete:

Program-specific onboarding (e.g., CLTS Waiver Standards, Family Care protocols)
Cultural competency and disability awareness training
Annual updates in state compliance and service documentation

7. MEDICAID PROGRAMS THAT COVER CASE MANAGEMENT SERVICES

Children’s Long-Term Support (CLTS) Waiver: Case management delivered through counties or contracted providers
Legacy Waivers / Community Integration Programs (CIP/COP): County-administered case management for adults
Family Care / Partnership: MCOs deliver case management internally via interdisciplinary care teams
IRIS Waiver: Case management is replaced with IRIS Consultant Agency (ICA) support, though external case managers may be involved in specific transitions or supplemental supports
Katie Beckett Program: Case coordination provided by state-employed staff or contractors

Note: Case management reimbursement and models vary widely across programs. Providers must align with each program’s structure and billing standards.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Manual Development

Timeline: 2–3 weeks

Phase: Staffing & Credentialing

Timeline: 30–45 days

Phase: Provider Enrollment / Contracting

Timeline: 1–3 months (may vary by program and county)

Phase: Begin Services

Timeline: After ISP approval and provider authorization

9. CONTACT INFORMATION

ForwardHealth Provider Portal

Website: https://www.forwardhealth.wi.gov

DHS Waiver Services & Children’s Programs

Website: https://www.dhs.wisconsin.gov/long-term-care-support.htm

Children’s Long-Term Support Waiver

Website: https://www.dhs.wisconsin.gov/clts

IRIS Consultant Agency Directory

Website: https://www.dhs.wisconsin.gov/iris/ica.htm

MCO Provider Directory – Family Care

Website: https://www.dhs.wisconsin.gov/familycare/mcos.htm

CASE MANAGEMENT SERVICES PROVIDER IN WISCONSIN

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

WCG supports solo case managers and human service agencies in launching and operating compliant, participant-centered case management services across Medicaid waiver programs.

Scope of Work: