Case Management Services in Kentucky are a core component of Medicaid’s Home and Community-Based Services (HCBS) waiver programs. Case managers serve as the primary coordinators of services, ensuring that participants receive timely, appropriate, and person-centered support in the least restrictive environment. Through ongoing assessment, care planning, and service monitoring, case managers help participants maintain independence and improve quality of life.

1. GOVERNING AGENCIES

Agency: Kentucky Cabinet for Health and Family Services (CHFS) — Department for Medicaid Services (DMS)
Role: Establishes provider qualifications, care planning requirements, and billing procedures for case management

Agency: Kentucky Department for Aging and Independent Living (DAIL)
Role: Provides oversight and quality assurance for case managers operating under aging and disability waivers

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures that case management services comply with federal Medicaid rules for person-centered planning, conflict-free case management, and participant rights

Agency: Managed Care Organizations (MCOs)
Role: Approve and monitor care plans, authorize services, credential providers, and process billing for HCBS participants

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2. SERVICE OVERVIEW

Case Management Services assist participants with assessing needs, identifying service options, coordinating providers, and monitoring outcomes. Services are delivered in accordance with the participant’s Person-Centered Service Plan (PCSP).

Approved activities include:

• Comprehensive needs assessments and re-assessments
• Development and updates of the PCSP
• Coordination of waiver and non-waiver services (e.g., medical, behavioral, housing)
• Facilitating interdisciplinary team meetings
• Monitoring health and safety status
• Addressing gaps in care or changes in condition
• Advocacy and crisis intervention
• Documentation and reporting to DMS or MCO

All case management must be conflict-free, meaning the case manager cannot deliver or have a financial interest in other HCBS services received by the participant.

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Kentucky Secretary of State
• Obtain IRS EIN and Type 2 NPI
• Enroll through the Medicaid Partner Portal Application (MPPA)
• Maintain general liability and professional liability insurance
• Employ or contract with qualified case managers (social workers, nurses, or human service professionals)
• Develop a Case Management Services Policy & Procedure Manual
• Ensure HIPAA compliance, quality assurance procedures, and secure documentation systems

4. KENTUCKY PROVIDER ENROLLMENT PROCESS

Step 1: Medicaid Enrollment via MPPA

• Apply as a Case Management Provider under the relevant HCBS waiver program
• Complete MCO credentialing for waiver-based case management

Step 2: Documentation Submission

• Submit proof of licensure, staff qualifications, insurance coverage, and program policies

Step 3: Program Implementation

• Establish referral networks, intake procedures, and care coordination workflows
• Begin service delivery per PCSP authorization and submit documentation for billing

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Kentucky business license
• IRS EIN and NPI verification
• Professional liability and general liability insurance

Case Management Policy & Procedure Manual, including:

• Intake and assessment templates
• Person-Centered Service Plan (PCSP) documentation
• Care coordination logs and service referral tracking
• Risk mitigation, incident reporting, and follow-up forms
• HIPAA and participant consent forms
• Staff credentialing and ongoing training logs
• Monthly monitoring and quarterly reassessment tools
• Medicaid billing templates and audit readiness protocols

6. STAFFING REQUIREMENTS

Role: Case Manager
Requirements: Bachelor’s or Master’s degree in social work, nursing, or a human services field, minimum of one year of experience with the waiver’s target population, cleared background check

Role: Program Supervisor (optional)
Requirements: Responsible for oversight of documentation, quality assurance, and staff development

All staff must complete:

• Person-centered planning training
• HIPAA and participant rights education
• Abuse, neglect, and exploitation prevention training
• Emergency response and crisis management protocols
• Annual continuing education to maintain licensure and program quality

7. MEDICAID PROGRAMS & HCBS WAIVERS

Case Management Services are authorized under:

• Home and Community Based (HCB) Waiver
• Michelle P. Waiver (MPW)
• Supports for Community Living (SCL) Waiver
• Acquired Brain Injury (ABI & ABI-LTC) Waivers
• Model II Waiver (MIIW)

Delivery settings may include:

• Participant’s home
• Community settings
• Virtual (telehealth) or phone-based follow-up when allowed

8. TIMELINE TO LAUNCH

Phase: Business Formation and Policy Manual Development
Timeline: 1–2 months

Phase: Medicaid Enrollment and MCO Credentialing
Timeline: 60–90 days

Phase: Staff Hiring and Referral Network Setup
Timeline: 30–45 days

Phase: Program Launch and Care Plan Coordination
Timeline: Ongoing as referrals and authorizations are received

9. CONTACT INFORMATION

Kentucky Department for Medicaid Services (DMS)
Website: https://chfs.ky.gov/agencies/dms

Medicaid Provider Enrollment (MPPA): https://mppa.ky.gov

Kentucky Department for Aging and Independent Living (DAIL)
Website: https://chfs.ky.gov/agencies/dail

Kentucky Cabinet for Health and Family Services (CHFS)
Website: https://chfs.ky.gov

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10. SCOPE OF WORK

• MPPA and MCO enrollment for HCBS case management
• Case Management Policy & Procedure Manual development
• Intake, assessment, and PCSP template creation
• Staff onboarding tools and licensure compliance checklists
• Quality assurance systems and monthly monitoring forms
• Referral outreach materials and relationship building strategies with MCOs, waiver teams, and hospitals

Waiver Consulting Group supports licensed professionals, nonprofits, and human services organizations in launching conflict-free, Medicaid-compliant Case Management Services across Kentucky.

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