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

Last reviewed: 2026-08-16

In Louisiana, Medicaid Case Management for Home and Community-Based Services (HCBS) is officially designated as "Support Coordination." Operating under a broker model, Support Coordination Agencies (SCAs) assist Medicaid-eligible individuals in gaining access to waiver services (such as the Community Choices Waiver and Residential Options Waiver) and State Plan services by conducting assessments, developing person-centered Plans of Care (POC), and monitoring service delivery without providing direct care themselves.

The single biggest structural barrier to entry for this service in Louisiana is the mandatory programmatic certification and Performance Agreement required by the Office of Aging and Adult Services (OAAS) or the Office for Citizens with Developmental Disabilities (OCDD). A provider cannot simply obtain a license and enroll in Medicaid; they must first be selected, certified, and sign a Performance Agreement with the specific state operating agency, which strictly controls network capacity and regional access.

1. Service Definition and Scope

Louisiana utilizes a broker model for case management, meaning the agency coordinates care but is strictly prohibited from providing direct waiver services to the same individual to prevent conflicts of interest. The service is officially termed Support Coordination across the state's HCBS waivers.

Support coordinators are responsible for the full lifecycle of participant management, from initial intake to ongoing monitoring, ensuring that the services outlined in the approved Plan of Care are delivered effectively and meet the participant's health and safety needs.

• Official Terminology: Support Coordination (formerly Case Management) [Support Coordination | Louisiana Department of Health](https://ldh.la.gov/office-of-intellectual-and-developmental-disability-supports/support-coordination).
• Core Functions: Intake, Assessment, Plan of Care (POC) Development and Implementation, and ongoing monitoring.
• Target Populations: Individuals enrolled in OAAS waivers (e.g., Community Choices) and OCDD waivers (e.g., Residential Options, Children's Choice).
• Service Limits: Billed as one unit per calendar month, not to exceed 12 units annually for standard ongoing coordination [La. Admin. Code tit. 50, § XXI-16333 - Support Coordination](https://www.law.cornell.edu/regulations/louisiana/La-Admin-Code-tit-50-SS-XXI-16333).
• Delivery Method: Virtual visits are permitted for routine monitoring, but initial and annual Plan of Care meetings have specific in-person requirements.

2. Regulatory and Oversight Agencies

The Louisiana Department of Health (LDH) serves as the umbrella agency overseeing all Medicaid and HCBS programs. Within LDH, regulatory duties are split between facility licensing, programmatic oversight, and Medicaid claims administration.

Providers must interact with the licensing division for their facility license, the specific program offices for waiver certification, and the state's fiscal intermediary for Medicaid enrollment and billing.

• Umbrella Agency: Louisiana Department of Health (LDH) (https://ldh.la.gov).
• Licensing Authority: LDH Health Standards Section (HSS) (https://ldh.la.gov/health-standards-section) issues the Case Management license.
• Adult Waiver Oversight: Office of Aging and Adult Services (OAAS) (https://ldh.la.gov/subhome/12) manages adult waivers and certifies providers.
• Developmental Disability Oversight: Office for Citizens with Developmental Disabilities (OCDD) (https://ldh.la.gov/subhome/11) manages ID/DD waivers.
• Medicaid Fiscal Intermediary: Gainwell Technologies (https://www.lamedicaid.com) manages the provider enrollment portal and MMIS.
• Managed Care Example: Aetna Better Health of Louisiana (https://www.aetnabetterhealth.com/louisiana/providers/portal.html) is one of the MCOs providers may contract with.

3. Gatekeeping Prerequisites: Who Can Even Apply

Louisiana heavily regulates the entry of new Support Coordination Agencies. Unlike some standard Medicaid services, you cannot simply submit a license application and begin billing; access is gated by programmatic need and regional network management by the state operating agencies.

Before Medicaid enrollment is even accepted, an applicant must secure a Performance Agreement from OAAS or OCDD. This acts as a structural precondition, meaning the state must actively want and approve your agency to operate in a specific region.

• Primary Barrier: OAAS or OCDD Certification and a signed Performance Agreement are absolute prerequisites prior to Medicaid enrollment [louisiana medicaid program issued: 04/13/22](https://www.lamedicaid.com/provweb1/Providermanuals/manuals/CCW2/CCW2_7.6_04-13-22.pdf).
• Regional Restrictions: Providers must be approved for and enroll as a Medicaid provider in all specific regions where they intend to provide services.
• Facility Need Review (FNR): While FNR is required for direct-care HCBS providers in Louisiana, Support Coordination access is gated directly by OAAS/OCDD regional network capacity rather than the formal HSS FNR process.
• Training Prerequisite: At least one support coordinator supervisor and one support coordinator must pass the state's assessment and care planning certification training before the agency can be certified.
• Material Approval: The agency's marketing brochure must be pre-approved by OAAS/OCDD before operations begin.
• Agency Contact Form: A completed OAAS/OCDD agency contact information form must be on file with the state.

4. Licensure and Certification Requirements

Agencies must first obtain a Case Management license from the LDH Health Standards Section (HSS). This process ensures the agency meets the baseline physical, organizational, and administrative standards required by state law.

Following HSS licensure, the agency must obtain the specific programmatic certification from OAAS or OCDD, which verifies the agency's capability to manage the specific waiver populations they intend to serve.

• Licensure Rule: Louisiana Administrative Code (LAC) 48:I., Chapter 49 (Case Management Licensing Standards) [Case Management | Louisiana Department of Health](https://ldh.la.gov/health-standards-section/hss-case-management).
• Application Packet: Submitted to LDH Health Standards Section with required licensing fees, organizational charts, and proof of commercial liability insurance.
• Programmatic Certification: Must be explicitly certified by LDH/OAAS or LDH/OCDD to provide support coordination services.
• Performance Agreement: Must sign and maintain the official OAAS or OCDD Performance Agreement.
• Medicaid Rulemaking: Must comply with Title 50, Part XV Subpart 7 (Targeted Case Management) regulations.

5. Medicaid Provider Enrollment

Once licensed by HSS and certified by OAAS/OCDD, the agency must enroll in the Louisiana Medicaid program through the web-based provider enrollment portal managed by Gainwell Technologies.

Enrollment with the state Medicaid agency is mandatory for all providers, even those who will ultimately bill through Managed Care Organizations (MCOs). Failure to complete this state-level enrollment will result in claim denials.

• Enrollment Portal: Louisiana Medicaid Provider Enrollment Portal via Gainwell Technologies (https://www.lamedicaid.com) [For Medicaid Providers | Louisiana Department of Health](https://ldh.la.gov/medicaid/for-medicaid-providers).
• Required Packet: Basic Provider Enrollment Packet for Entities/Businesses [State of Louisiana | Provider Enrollment](https://www.lamedicaid.com/provweb1/provider_enrollment/newenrollments.htm).
• Provider Type: Must enroll specifically as a Support Coordination agency using the appropriate taxonomy and provider type codes.
• NPI Requirement: Must obtain a National Provider Identifier (NPI) and link it to the Louisiana Provider ID during enrollment.
• MCO Credentialing: After state enrollment, providers must separately credential and contract with Louisiana Medicaid MCOs (e.g., Humana Healthy Horizons, Aetna Better Health).
• Status Verification: Providers must use the Provider Portal Enrollment Status Lookup Tool to confirm active status before billing.

6. Staffing, Training and Background Checks

Louisiana mandates strict educational and experiential qualifications for Support Coordinators and their supervisors to ensure high-quality care planning. Agencies must maintain specific staffing ratios and ensure continuous coverage.

All personnel must pass state-mandated training modules and comprehensive background checks before they are permitted to have direct contact with waiver participants or access their protected health information.

• Supervisor Qualifications: Must meet LDH education and experience requirements, typically requiring a bachelor's or master's degree in a human services field plus relevant post-degree experience.
• Coordinator Qualifications: Must possess a bachelor's degree in a human service field or equivalent experience as strictly defined by LDH regulations.
• Mandatory Training: Staff must pass the state's official assessment and care planning certification training prior to managing cases [louisiana medicaid program issued: 04/13/22](https://www.lamedicaid.com/provweb1/Providermanuals/manuals/CCW2/CCW2_7.6_04-13-22.pdf).
• Background Checks: Comprehensive criminal background checks are required for all staff prior to employment and client contact.
• Roster Maintenance: Agencies must maintain an active, up-to-date roster of certified coordinators and supervisors with the state.
• Caseload Limits: Agencies must adhere to state-mandated maximum caseload ratios per support coordinator to ensure adequate monitoring.

7. Documentation, Policies and Records

Support Coordination Agencies must maintain comprehensive records that prove compliance with the broker model of case management. Documentation must clearly show that the agency is assessing needs, planning care, and monitoring services without bias.

Strict separation from direct service provision is required to avoid conflicts of interest. Agencies must maintain written policies and participant records that demonstrate adherence to Freedom of Choice requirements.

• Plan of Care (POC): Must develop, implement, and continuously update the individualized POC based on the participant's assessed needs.
• Freedom of Choice (FOC): Must document that participants were offered a choice of direct service providers using the official LDH FOC form.
• Contact Logs: Detailed documentation of all virtual and in-person visits, including initial assessments, quarterly reviews, and annual reassessments.
• Conflict of Interest Policy: Written policies ensuring the SCA does not provide direct care services (like personal care or home health) to its coordination clients.
• Emergency Protocols: Documented procedures for participant safety and continuity of care during emergencies, hurricanes, or natural disasters.
• Brochure Approval: The agency's informational brochure must be kept on file and show proof of OAAS/OCDD approval.

8. Billing, Rates and Claims

Support Coordination is billed through the Medicaid Management Information System (MMIS) operated by Gainwell Technologies for Fee-For-Service participants, or through the respective MCO's clearinghouse for managed care participants.

Services are typically billed on a monthly unit basis, and claims must align perfectly with the approved prior authorization and the participant's active Plan of Care.

• Billing System: Gainwell Technologies MMIS for Fee-For-Service; Availity or similar portals for MCO claims.
• Unit Definition: One calendar month equals one billing unit [La. Admin. Code tit. 50, § XXI-16333 - Support Coordination](https://www.law.cornell.edu/regulations/louisiana/La-Admin-Code-tit-50-SS-XXI-16333).
• Maximum Limits: Standard support coordination shall not exceed 12 units per calendar year.
• Rate Structure: Reimbursed at a flat monthly rate established by LDH, subject to legislative appropriations.
• Prior Authorization: Claims must include the approved prior authorization number linked to the participant's POC.
• Timely Filing: Claims must be submitted within Louisiana Medicaid's strict timely filing limits to avoid denial.

9. Approval Sequence and Timeline

Becoming an approved Support Coordination Agency in Louisiana is a sequential, multi-step process that can take several months. Providers cannot skip steps or apply for Medicaid enrollment before programmatic certification is secured.

The timeline is heavily dependent on the provider's ability to pass the mandatory training, secure the Performance Agreement, and submit error-free applications to both HSS and Gainwell Technologies.

• Step 1: Establish the corporate entity, develop required policies, and prepare the agency brochure for state review.
• Step 2: Apply for Case Management Licensure through the LDH Health Standards Section (HSS).
• Step 3: Complete mandatory state assessment and care planning certification training for supervisors and coordinators.
• Step 4: Obtain OAAS/OCDD Certification and sign the official Performance Agreement.
• Step 5: Submit the Basic Provider Enrollment Packet to Gainwell Technologies via the Louisiana Medicaid portal.
• Step 6: Upon state Medicaid approval, credential and contract with Louisiana Medicaid MCOs.

10. Common Denials and Survey Findings

LDH Health Standards Section and the program offices (OAAS/OCDD) conduct regular surveys and audits of Support Coordination Agencies. Providers frequently face citations or enrollment denials due to administrative errors or failure to meet strict programmatic guidelines.

Maintaining perfect documentation of participant contacts and adhering to the broker model's conflict-of-interest rules are the most critical areas for compliance.

• Enrollment Denial: Submitting the Medicaid enrollment packet to Gainwell before obtaining the required OAAS/OCDD Performance Agreement.
• Survey Citation: Failure to complete the annual Plan of Care (POC) reassessment within the strict 365-day timeframe.
• Survey Citation: Missing, incomplete, or unsigned Freedom of Choice (FOC) forms in participant files.
• Survey Citation: Billing for a monthly unit without meeting the minimum required contact or visit thresholds for that month.
• Enrollment Delay: Submitting an incomplete Basic Provider Enrollment Packet or missing required signatures on the entity application.
• Survey Citation: Employing support coordinators who have not passed the mandatory state certification training.

11. Key Contacts and Resources

Prospective providers should utilize the official Louisiana Department of Health portals and the Gainwell Technologies provider site for the most current manuals, forms, and fee schedules.

Direct communication with the specific program office (OAAS or OCDD) is essential for understanding regional capacity and certification requirements.

• LDH Health Standards Section (HSS): https://ldh.la.gov/health-standards-section
• Louisiana Medicaid Provider Portal (Gainwell): https://www.lamedicaid.com
• Office of Aging and Adult Services (OAAS): https://ldh.la.gov/subhome/12
• Office for Citizens with Developmental Disabilities (OCDD): https://ldh.la.gov/subhome/11
• Louisiana Administrative Code (LAC): https://www.doa.la.gov/doa/osr/louisiana-administrative-code/
• Humana Healthy Horizons (MCO Credentialing): https://provider.humana.com/medicaid/louisiana-medicaid/credentialing

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