1. Program Definition and Services

Case Management Services, frequently designated as Support and Service Coordination in Wisconsin, provide person-centered assessment, care planning, and ongoing monitoring to help individuals with disabilities, mental health conditions, chronic illnesses, or age-related needs access and navigate long-term community supports. Services include:

• Assessment & Service Plan Development: Execution of comprehensive functional evaluations and regular updates to the Individualized Service Plan reflecting participant goals, medical necessity, and risk mitigation
• Coordination & Ongoing Monitoring: Streamlining formal waiver services, establishing links to localized community resources, facilitating medical appointments, and performing mandated check-ins to evaluate care delivery

2. Regulations

The program is governed by the following regulations:

• Wisconsin Administrative Code 
• Wisconsin Children’s Long-Term Support (CLTS) Waiver Program Manual Standards
• Wisconsin Caregiver Background Check Law and Misconduct Reporting Standards
• Federal Home and Community-Based Services (HCBS) Final Settings Rule 

3. Licensing or Certification

Operating agencies do not require a specialized health facility license to coordinate waiver-based case management. However, agencies must achieve approved provider enrollment status through ForwardHealth or the CLTS Provider Registry and satisfy strict staff-level educational and experiential standards.

4. Responsible State Agency

The Wisconsin Department of Health Services (DHS), via the Division of Medicaid Services, acts as the primary administrative and policy-setting authority. Provider profile verification and claims processing are handled through ForwardHealth. 

5. Application Process

• Register the corporate entity with the Wisconsin DFI to obtain formal business registration
• Secure an EIN and a corporate Type 2 National Provider Identifier (NPI) via NPPES
• Submit a provider enrollment application 
• Upload the agency's operational manual, crisis safety plans, and professional resumes of qualified staff
• Execute specialized provider or Master Service Agreements 
• Initiate case assignments 

6. Required Documentation

• Verified DFI business registration papers, active Federal EIN, and Type 2 NPI
• Case Management Services Policy & Procedure Manual 
• Templates for case notes, ISP revisions, monthly monitoring worksheets, and client grievance tracking logs
• Certificates of professional liability insurance (errors and omissions) and commercial general liability insurance
• Employee credentialing files

7. Timeline for Approval

The combined processing pipeline spanning corporate registration, manual compilation, ForwardHealth/Registry application vetting, and county or MCO network onboarding typically averages 1 to 3 months.

8. Pre-Application Process

Prospective providers must form an LLC or Corporation with the Wisconsin DFI, secure an EIN, and obtain a corporate Type 2 NPI. Agencies must establish secure, HIPAA-compliant electronic health record ($EHR$) networks capable of logging granular service details, case interactions, and place-of-service tags.

9. Pre-Application Training

The state requires comprehensive documentation of staff orientation competencies before managing active cases. Agency owners and coordinators must verify completion of training sequences covering CLTS Waiver Standards or Family Care protocols, civil rights, client confidentiality boundaries, fraud detection, and person-centered planning frameworks.

10. Additional Notes

• Case managers must possess a Bachelor’s degree in a human services-related field (social work, psychology, nursing, etc.) and at least 1 year of supervised experience working with the target population, or 2 years of supervised experience if no qualifying human services degree is held
• Case management billing is restricted to non-institutional environments, ongoing monitoring cannot be reimbursed while a participant resides in a skilled nursing facility or hospital, except for authorized discharge planning within 30 days of release
• Daily service logs must record precise interaction dates, names of participating parties, place-of-service locations, targeted ISP goals, and explicit outcomes to satisfy state Medicaid financial audits and prevent retroactive funding clawbacks

Why Choose Waiver Consulting Group?

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.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

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