CASE MANAGEMENT SERVICES PROVIDER IN NEVADA

Fatumata Kaba
Sep 4
4 min read

COORDINATING CARE AND SUPPORT THROUGH PERSON-CENTERED CASE MANAGEMENT

Case Management Services in Nevada support individuals with disabilities, chronic conditions, or other long-term care needs by coordinating services, managing care plans, and facilitating access to community resources. These services ensure that individuals receive comprehensive, person-centered care. Case Management Services are authorized under Nevada Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: Nevada Department of Health and Human Services (DHHS)

Role: Administers Medicaid waiver funding for Case Management Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Aging and Disability Services Division (ADSD)

Role: Ensures quality standards, service delivery, and compliance for Case Management Services under HCBS waiver programs.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight, ensuring Medicaid-funded Case Management Services meet HCBS quality, person-centered planning, and participant protection standards.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management Services involve coordinating and managing care to enhance an individual’s ability to live independently and safely within the community.

Approved providers may deliver:

Needs Assessment: Identifying the individual's care requirements through a comprehensive evaluation.
Service Planning: Developing an Individualized Service Plan (ISP) based on assessed needs.
Care Coordination: Arranging medical, social, and community services.
Monitoring and Follow-Up: Regularly reviewing progress and updating care plans as needed.
Crisis Intervention: Managing emergencies and coordinating responses.
Resource Navigation: Assisting with accessing community support, financial aid, and housing.
Advocacy: Ensuring that individuals receive appropriate services and support.

All services are delivered according to the ISP to meet the specific needs and preferences of the participant.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register the business entity with the Nevada Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Case Management provider via the Nevada Medicaid Provider Enrollment Portal.
Obtain any necessary licensure for case management services from DHHS if applicable.
Maintain general liability and professional liability insurance.
Develop policies for care coordination, emergency response, and documentation.
Ensure staff meet background checks, health screenings, and case management training requirements.

4. NEVADA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Complete the Provider Enrollment Application through the Nevada Medicaid Provider Enrollment Portal for Case Management Services under HCBS waivers.

Application and Documentation Submission:

Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, staff qualifications, and policy manuals.

Program Readiness Review:

DHHS and ADSD evaluate provider readiness, including staff qualifications, service planning protocols, and safety measures.

Approval & Medicaid Enrollment:

Upon successful review, providers receive authorization to bill Medicaid for Case Management Services using designated billing codes.

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (Nevada Secretary of State)
IRS EIN confirmation
NPI confirmation
Proof of general and professional liability insurance
Case Management Services Policy & Procedure Manual, including:
- Participant intake, needs assessment, and care planning procedures
- Coordination of healthcare, social, and community-based services
- Crisis intervention and emergency response protocols
- Staff credentialing, background checks, and ongoing training records
- HIPAA compliance, participant rights, and grievance handling
- Documentation standards for service coordination and Medicaid billing
- Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Case Management Program Director

Requirements: Bachelor’s or Master’s degree in social work, human services, or healthcare; certification in case management preferred; supervisory experience.

Role: Case Managers

Requirements: Bachelor’s degree in social work, healthcare, or a related field; experience in care coordination and service planning; background clearance.

Role: Case Management Assistants

Requirements: High school diploma or GED; experience in administrative support and data entry; background clearance.

All staff must complete:

Training in person-centered planning and case management practices
HIPAA compliance and participant rights education
Crisis management and de-escalation techniques
Annual competency evaluations and continuing education
Ongoing training in service coordination and resource management

7. MEDICAID WAIVER PROGRAMS

Case Management Services are available under the following Nevada Medicaid Waivers:

Home and Community-Based Waiver for Persons with Intellectual and Developmental Disabilities (HCBS-IDD)
Frail Elderly (FE) Waiver
Physical Disabilities Waiver
Traumatic Brain Injury (TBI) Waiver
Aged and Disabled (AD) Waiver

Services may include: