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

Last reviewed: 2026-09-10

The Minnesota Department of Human Services (DHS) funds HCBS Case Management through the Brain Injury (BI), Community Alternative Care (CAC), Community Access for Disability Inclusion (CADI), Developmental Disabilities (DD), and Elderly Waiver (EW) programs. Private agencies seeking to provide this service cannot enroll independently; they must secure a contract directly with a county of financial responsibility, an enrolled tribal nation, or a Managed Care Organization (MCO) acting as the lead agency.

Under Minnesota Statutes section 256B.49, private case management agencies are strictly prohibited from having any financial interest in the provision of other waiver services included in a person's support plan. Approved providers must register through the Minnesota Provider Screening and Enrollment (MPSE) portal and utilize the MN–ITS system to receive service authorizations and submit claims.

1. Service Definition and Scope

In Minnesota, HCBS Case Management assists waiver participants in gaining access to needed waiver and other State plan services, as well as medical, social, educational, and other services. The service includes assessment, person-centered service planning, referral, and ongoing monitoring.

The county of financial responsibility or enrolled tribal nation arranges the provision of BI, CAC, CADI, and DD waiver case management. Lead agencies maintain the authority to choose the providers with whom they contract to deliver these services.

2. Regulatory and Oversight Agencies

The Minnesota Department of Human Services (DHS) is the primary state agency responsible for Medicaid waiver administration and provider enrollment. Within DHS, specific divisions handle licensing, policy, and provider screening.

Lead agencies, which include counties, tribal nations, and Managed Care Organizations (MCOs), provide direct oversight, contracting, and service authorization for case management providers.

3. Gatekeeping Prerequisites: Who Can Even Apply

Minnesota does not allow open, independent enrollment for private HCBS case management agencies. A private entity must first be selected and contracted by a lead agency (a county, tribe, or MCO). Minnesota's federally approved waiver plan explicitly gives lead agencies the authority to choose the providers with whom they contract.

Additionally, Minnesota enforces strict conflict-free case management rules. Under Minnesota Statutes 256B.49, a private agency cannot provide case management if it has any financial interest in the provision of any other services included in the recipient's support plan.

4. Licensure and Certification Requirements

Minnesota does not issue a distinct facility or agency license specifically for HCBS Case Management. Instead, approval is based on meeting professional qualification standards, securing a lead agency contract, and passing the DHS provider enrollment screening.

Providers must maintain documentation supporting their qualifications to provide waiver services as defined in the Community-Based Services Manual (CBSM) and ensure all staff meet the educational and experience requirements.

5. Medicaid Provider Enrollment

Agencies that have secured a lead agency contract must enroll as a Minnesota Health Care Programs (MHCP) provider. This is done through the Minnesota Provider Screening and Enrollment (MPSE) portal.

Providers must submit the HCBS Programs Service Request Form (DHS-6638) to report the services they intend to provide and demonstrate their qualifications.

6. Staffing, Training and Background Checks

Case managers must meet specific educational and experience requirements to deliver services. The state defines these qualifications strictly in the CBSM and administrative rules.

Staff must pass required background studies initiated through the DHS NETStudy 2.0 system before having direct contact with waiver participants.

7. Documentation, Policies and Records

Case management agencies must maintain comprehensive records of person-centered planning, assessments, and monitoring visits. Documentation must comply with the Minnesota Olmstead Plan and HCBS settings rules.

Providers must utilize state-mandated forms for transition and choice, and ensure all service authorizations are accurately reflected in the participant's file.

8. Billing, Rates and Claims

Billing for case management is processed through the Medicaid Management Information System (MMIS) via the MN-ITS portal. Providers can only bill for services that have an approved Service Authorization (SA).

The SA details the approved procedure codes, rate of payment, number of units, and date spans. An approved SA is required but does not guarantee payment if eligibility is lost.

9. Approval Sequence and Timeline

The approval sequence begins at the local level. A prospective agency must first negotiate and sign a contract with a county, tribe, or MCO lead agency.

Once contracted, the agency submits an enrollment application via MPSE. DHS reviews the application and HCBS settings attestation, typically responding within 30 days.

10. Common Denials and Survey Findings

Applications are frequently rejected if a private agency attempts to enroll without a pre-existing lead agency contract. DHS will not process standalone case management enrollments.

During audits or lead agency reviews, common findings include failure to meet face-to-face visit frequency requirements and violations of conflict-free case management rules.

11. Key Contacts and Resources

Providers should utilize the DHS website and the Community-Based Services Manual (CBSM) for the most current policy updates and enrollment instructions.

Local county and tribal offices are the primary point of contact for securing the necessary contracts to provide case management.

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