Arkansas - Case Management Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Arkansas, Case Management Services—often designated as Targeted Case Management (TCM) or HCBS Waiver Case Management—are critical services that provide assessment, person-centered service planning, referral, and ongoing monitoring for vulnerable populations. These services are primarily delivered through the state's Medicaid waiver programs, such as the Community and Employment Supports (CES) Waiver for individuals with developmental disabilities, and specialized behavioral health programs.

The single biggest structural barrier to entry for a prospective case management provider in Arkansas is the mandatory network contracting and credentialing with the state's Provider-Led Arkansas Shared Savings Entities (PASSEs). While basic state certification and Medicaid enrollment are open to all qualified applicants, a provider cannot actually bill for the vast majority of HCBS case management recipients without securing active contracts with these managed care organizations, which operate on their own independent credentialing timelines.

1. Service Definition and Scope

Arkansas Medicaid defines Case Management as services that assist eligible individuals in gaining access to needed medical, social, educational, and other services. This includes comprehensive assessment, development of a person-centered service plan (PCSP), referral activities, and ongoing monitoring.

The scope of practice is strictly non-direct care; case managers coordinate and monitor the delivery of the client's full service package but do not provide the underlying medical or personal care services themselves.

• Target Populations: Primarily serves individuals with developmental disabilities (via the CES Waiver), individuals with severe behavioral health needs, and frail elders.
• Comprehensive Assessment: Requires gathering detailed information about the individual's needs, strengths, and preferences to inform care planning.
• Service Planning: Involves the creation and periodic revision of a formal Person-Centered Service Plan (PCSP) that outlines specific goals and authorized services.
• Referral and Linkage: Mandates connecting the beneficiary with appropriate clinical, social, and community resources.
• Monitoring and Follow-up: Requires regular contacts (both face-to-face and collateral) to ensure services are being implemented as planned and are meeting the client's needs.
• Conflict of Interest: Case management agencies must maintain structural separation from direct care service provision to prevent self-referral, per federal HCBS settings rules.

2. Regulatory and Oversight Agencies

The Arkansas Department of Human Services (DHS) is the umbrella agency overseeing all Medicaid and HCBS programs. Within DHS, specific divisions handle distinct phases of provider approval, certification, and enrollment.

Once enrolled, providers must also interact with the PASSEs, which act as managed care organizations responsible for authorizing and paying for services for high-need populations.

• Arkansas Department of Human Services (DHS): The overarching state agency managing health and human services (https://humanservices.arkansas.gov).
• Division of Provider Services and Quality Assurance (DPSQA): The division responsible for certifying case management providers and conducting compliance surveys (https://humanservices.arkansas.gov/divisions-shared-services/provider-services-quality-assurance/).
• Division of Medical Services (DMS): The state Medicaid agency that manages provider enrollment and MMIS operations (https://humanservices.arkansas.gov/divisions-shared-services/medical-services/).
• Division of Developmental Disabilities Services (DDS): Oversees policy and programmatic rules for the CES Waiver (https://humanservices.arkansas.gov/divisions-shared-services/developmental-disabilities-services/).
• Arkansas MMIS Provider Portal: The electronic system used for submitting Medicaid enrollment applications and fee-for-service claims (https://portal.mmis.arkansas.gov/armedicaid/provider/Home/tabid/135/Default.aspx).

3. Gatekeeping Prerequisites: Who Can Even Apply

Arkansas does not utilize a Certificate of Need (CON) program for case management agencies, nor does it restrict basic Medicaid enrollment through closed Request for Proposals (RFP) or moratoria. Enrollment at the state level is generally open to any willing and qualified provider.

However, structural prerequisites exist before an application can be processed. Providers must obtain state certification before applying for Medicaid enrollment, and must secure managed care contracts to actually operate.

• Certificate of Need (CON): None required; Arkansas does not subject case management or HCBS waiver agencies to CON review.
• Procurement/RFP: None required for basic enrollment; DDS and DMS provide continuous open enrollment for waiver service providers.
• Prior Certification Requirement: Applicants must be certified by DPSQA before the DMS Provider Enrollment Unit will accept or approve a Medicaid enrollment application.
• In-State Location Mandate: Per Arkansas Medicaid rules, providers must be physically located within the State of Arkansas or an approved border city to be eligible to participate.
• PASSE Contracting Prerequisite: To bill for CES Waiver or intensive behavioral health case management, providers must successfully contract and credential with at least one of the state's designated PASSEs (e.g., Arkansas Total Care, Empower Healthcare Solutions).

4. Licensure and Certification Requirements

Arkansas does not issue a traditional "facility license" for case management. Instead, agencies must obtain and maintain Provider Certification through the Division of Provider Services and Quality Assurance (DPSQA).

Certification is tied to compliance with the Arkansas Administrative Code (e.g., Rule 016.27.20-006) and specific waiver manuals, requiring proof of qualified personnel, physical office standards, and operational policies.

• Authority: Certification is governed by Arkansas Administrative Code and DPSQA provider manuals.
• Application Packet: Providers must submit a comprehensive certification packet to DPSQA, including organizational charts, policies, and proof of physical address.
• Physical Office: Agencies must maintain a commercial office space in Arkansas that meets ADA accessibility and HIPAA privacy standards.
• Annual Renewal: Case management providers must be recertified by DPSQA on an annual basis.
• Site Visits: DPSQA and DDS conduct announced and unannounced on-site reviews prior to initial certification and during the annual renewal process.

5. Medicaid Provider Enrollment

Following DPSQA certification, agencies must enroll as billing providers through the Arkansas MMIS Provider Portal. Paper applications are generally not accepted for initial enrollment.

Strict data matching is enforced during this stage. The legal name, Tax Identification Number (TIN), and physical address must match exactly across all submitted documents, or the application will be automatically rejected.

• System: Applications must be submitted electronically via the Arkansas MMIS Provider Portal (https://portal.mmis.arkansas.gov/armedicaid/provider/Home/tabid/135/Default.aspx).
• Form DMS-652: The official Arkansas Medicaid Provider Application form, integrated into the portal.
• Form DMS-653: The Arkansas Medicaid Provider Contract, which permits original or approved electronic signatures.
• W-9 Matching: The submitted W-9 must exactly match IRS records and the name listed on the DPSQA certification.
• EFT Authorization: Electronic Funds Transfer is the only payment method available; requires a voided check or bank verification letter.
• Taxonomy Code: Providers must select the appropriate taxonomy code for Case Management (e.g., 251B00000X) during portal registration.

6. Staffing, Training and Background Checks

Case management agencies must employ staff who meet specific educational and experiential thresholds. Because case managers operate independently in the community, background screening is rigorously enforced.

Agencies must also maintain a roster of all active practitioners and report changes to the state monthly.

• Educational Qualifications: Case managers typically must hold a current Arkansas license as a Registered Nurse (RN) or Social Worker, or possess a Bachelor's degree in a human services field with at least one year of relevant experience.
• Criminal Background Checks: Mandatory fingerprint-based state and national criminal history checks via the Arkansas State Police.
• Maltreatment Registries: Staff must clear both the Arkansas Child Maltreatment Registry and the Adult Abuse Registry prior to client contact.
• OMIG Notification: Providers must notify the Office of the Medicaid Inspector General (OMIG) by the 10th of each month of any additions or terminations of covered health care practitioners.
• Mandatory Training: Staff must complete state-mandated training on incident reporting, person-centered planning, and PASSE-specific protocols upon hire and annually thereafter.
• Supervision: Non-licensed case managers must receive documented, regular supervision from a licensed professional or a supervisor with advanced experience.

7. Documentation, Policies and Records

Arkansas Medicaid requires exhaustive documentation to justify the billing of case management services. Records must clearly demonstrate that the services provided align with the goals established in the individual's PCSP.

Agencies must maintain comprehensive policy manuals covering HIPAA compliance, incident reporting, and grievance procedures, which are reviewed during DPSQA audits.

• Person-Centered Service Plan (PCSP): Must be developed, signed by the client/guardian, and updated at least annually or upon a significant change in condition.
• Contact Notes: Every billed encounter must be documented with the date, start and stop times, modality (face-to-face vs. phone), and the specific PCSP goal addressed.
• Record Retention: Arkansas Medicaid policy requires all clinical and billing records to be retained for a minimum of five (5) years from the date of service.
• Incident Reporting: Critical incidents must be reported to DPSQA and the client's PASSE within 48 hours of discovery.
• HIPAA Policies: Agencies must maintain written policies for the physical and electronic security of Protected Health Information (PHI).
• Grievance Procedures: Must have a documented process for clients to file complaints without fear of retaliation, including contact information for state ombudsman programs.

8. Billing, Rates and Claims

While enrolled in the state MMIS, the majority of HCBS case management claims in Arkansas are submitted directly to the PASSEs rather than the state fee-for-service system. Providers must navigate the clearinghouses and portals specific to each managed care organization.

Services are typically billed in time-based increments, and prior authorization is strictly required before services can be rendered and billed.

• Billing Portals: Claims for PASSE members are submitted to the respective PASSE portal (e.g., Arkansas Total Care, Empower); FFS claims go through the MMIS Provider Portal.
• HCPCS Codes: Services are generally billed using standard codes such as T1016 (Case management, each 15 minutes).
• Prior Authorization: Mandatory for case management services; authorizations are issued by the PASSE based on the approved PCSP.
• Claim Format: Claims must be submitted in the standard CMS-1500 format or the electronic 837P equivalent.
• Timely Filing: Arkansas Medicaid and PASSEs generally require claims to be submitted within 365 days of the date of service.
• Payment Method: All reimbursements are issued via Electronic Funds Transfer (EFT).

9. Approval Sequence and Timeline

Becoming a fully operational case management provider in Arkansas is a sequential, multi-step process. Providers cannot initiate Medicaid enrollment until DPSQA certification is in hand, and cannot credential with PASSEs until Medicaid enrollment is active.

Prospective agencies should plan for a minimum of 4 to 6 months from the initial submission of the certification packet to the receipt of the first PASSE contract.

• Step 1: DPSQA Certification: Submission of policies and application to DPSQA; typically takes 30 to 60 days including site review.
• Step 2: MMIS Enrollment: Electronic submission via the Provider Portal; processing takes approximately 30 to 45 days if all documents match.
• Step 3: PASSE Credentialing: Applying to individual PASSE networks; takes 60 to 90 days per plan.
• Step 4: PASSE Contracting: Finalizing rates and network inclusion agreements after credentialing approval.
• Revalidation: Providers must revalidate their Arkansas Medicaid enrollment every five (5) years.

10. Common Denials and Survey Findings

The Arkansas DHS Provider Enrollment Unit and DPSQA surveyors strictly enforce administrative and clinical rules. Minor clerical errors during enrollment or documentation gaps during operations frequently lead to application rejections or audit citations.

Understanding these common pitfalls allows providers to implement quality assurance checks before submitting applications or facing state surveys.

• Enrollment Denial 1: Name mismatches between the W-9, DPSQA certification, and the MMIS application (the single most common cause of denial).
• Enrollment Denial 2: Missing or incomplete attachments, such as failing to provide a voided check for the EFT authorization.
• Survey Finding 1: Failure to update the Person-Centered Service Plan annually or when the client experiences a major life change.
• Survey Finding 2: Case notes that lack specific start and stop times, or notes that describe generic check-ins rather than addressing specific PCSP goals.
• Survey Finding 3: Missing background check results or maltreatment registry clearances in employee personnel files.
• Survey Finding 4: Billing for case management activities that occurred while the beneficiary was admitted to an inpatient hospital or institution.

11. Key Contacts and Resources

Providers must maintain active communication with state divisions and managed care entities. Utilizing the official portals and provider relations contacts is essential for resolving enrollment and billing issues.

Below are the authoritative links for Arkansas Medicaid case management enrollment and oversight.

• DHS Provider Enrollment Unit: Manages MMIS applications and updates (https://humanservices.arkansas.gov/divisions-shared-services/medical-services/provider-enrollment/).
• DPSQA Certification Unit: Handles initial provider certification and annual renewals (https://humanservices.arkansas.gov/divisions-shared-services/provider-services-quality-assurance/).
• Arkansas MMIS Provider Portal: The gateway for electronic enrollment and FFS billing (https://portal.mmis.arkansas.gov/armedicaid/provider/Home/tabid/135/Default.aspx).
• Arkansas Total Care (PASSE): Managed care organization for behavioral health and DD populations (https://www.arkansastotalcare.com).
• Empower Healthcare Solutions (PASSE): Managed care organization for behavioral health and DD populations (https://www.getempowerhealth.com).
• Summit Community Care (PASSE): Managed care organization for behavioral health and DD populations (https://www.summitcommunitycare.com).

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