1. Program Definition and Services

Case Management Services (Support Coordination) in Tennessee provide person-centered advocacy and systemic organization for Medicaid waiver participants with intellectual, developmental, or medical needs. The program aims to coordinate community-based resources, averting institutional care by stabilizing home systems. Services include:

• Care Coordination: Completing objective needs assessments, organizing and authoring Individual Support Plans (ISPs), and arranging provider logistics
• Systemic Monitoring: Monthly service delivery tracking, crisis response coordination, transition planning from care facilities, and resource linkage

2. Regulations

The program is governed by the following regulations:

• TennCare Rules and Regulations, Chapter 1200-13-01 (Managed Care Long-Term Services and Supports Compliance)
• Department of Intellectual and Developmental Disabilities (DIDD) Support Coordination Operational Guidelines
• Federal Conflict-Free Case Management Mandates (42 CFR 441.301(c)(1))
• Tennessee Title 33 Behavioral and Developmental Disability Care Coordination Rules

3. Licensing or Certification

Providers must be certified by the Department of Intellectual and Developmental Disabilities (DIDD) and fully approved by individual TennCare Managed Care Organizations (MCOs).

4. Responsible State Agency

The Bureau of TennCare and the Department of Intellectual and Developmental Disabilities (DIDD) are responsible for reviewing agency infrastructure and certifying case management services providers.

5. Application Process

The application process is conducted through the electronic DIDD Vendor Enrollment Unit and TennCare Network Portals. Providers must submit conflict-free operational declarations online to initiate processing.

6. Required Documentation

While specific documentation requirements vary based on the target waiver, providers typically need to submit:

• Proof of compliance with federal conflict-free case management operating structures
• Case Management Policy & Procedure Manual (including crisis response and quality monitoring metrics)
• Case manager staff college degrees, resume files, and background check records
• Proof of professional liability, cybersecurity data breach insurance, and general liability coverage

7. Timeline for Approval

The exact timeline for approval fluctuates based on agency capacity. Providers should contact the DIDD Office of Business Services for detailed information on current administrative review cycles.

8. Pre-Application Process

Prospective providers must complete specific foundation tasks before applying. They must register the legal entity with the Tennessee Secretary of State, secure an EIN, and acquire an administrative Type 2 National Provider Identifier (NPI).

9. Pre-Application Training

The state hosts mandatory administrative and compliance training sessions online. Access details for the person-centered planning curriculum and state ISP data entry systems are sent to qualified applicants once preliminary paperwork is reviewed.

10. Additional Notes

• Providers must ensure that their business model contains no direct HCBS care delivery arms, maintaining strict compliance with conflict-free rules
• Support Coordination workflows must occur in consistent alignment with individual self-determination frameworks
• All care managers must conduct mandatory background clearances, degree verifications, and fingerprinting registry screenings
• Providers must maintain detailed records of face-to-face monthly monitoring checks and comprehensive contact logs for Medicaid documentation

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Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

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