COORDINATING CARE AND SUPPORT THROUGH PERSON-CENTERED CASE MANAGEMENT

Case Management Services in Nevada support individuals with disabilities, chronic conditions, or other long-term care needs by coordinating services, managing care plans, and facilitating access to community resources. These services ensure that individuals receive comprehensive, person-centered care. Case Management Services are authorized under Nevada Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: Nevada Department of Health and Human Services (DHHS)
Role: Administers Medicaid waiver funding for Case Management Services and manages provider enrollment, service authorization, and reimbursement.

Agency: Aging and Disability Services Division (ADSD)
Role: Ensures quality standards, service delivery, and compliance for Case Management Services under HCBS waiver programs.

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Case Management Services meet HCBS quality, person-centered planning, and participant protection standards.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management Services involve coordinating and managing care to enhance an individual’s ability to live independently and safely within the community.

Approved providers may deliver:

• Needs Assessment: Identifying the individual's care requirements through comprehensive evaluation
• Service Planning: Developing an Individualized Service Plan (ISP) based on assessed needs
• Care Coordination: Arranging medical, social, and community services
• Monitoring and Follow-Up: Regularly reviewing progress and updating care plans as needed
• Crisis Intervention: Managing emergencies and coordinating responses
• Resource Navigation: Assisting with accessing community support, financial aid, and housing
• Advocacy: Ensuring that individuals receive appropriate services and support

All services are delivered according to the ISP to meet the specific needs and preferences of the participant.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register the business entity with the Nevada Secretary of State
• Obtain EIN from the IRS and NPI (Type 2)
• Enroll as a Medicaid Waiver Case Management provider via the Nevada Medicaid Provider Enrollment Portal
• Obtain any necessary licensure for case management services from DHHS if applicable
• Maintain general liability and professional liability insurance
• Develop policies for care coordination, emergency response, and documentation
• Ensure staff meet background checks, health screenings, and case management training requirements

4. NEVADA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Complete the Provider Enrollment Application through the Nevada Medicaid Provider Enrollment Portal for Case Management Services under HCBS waivers

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, staff qualifications, and policy manuals

Program Readiness Review:

• DHHS and ADSD evaluate provider readiness, including staff qualifications, service planning protocols, and safety measures

Approval & Medicaid Enrollment:

• Upon successful review, providers receive authorization to bill Medicaid for Case Management Services using designated billing codes

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (Nevada Secretary of State)
• IRS EIN confirmation
• NPI confirmation
• Proof of general and professional liability insurance

Case Management Services Policy & Procedure Manual including:

• Participant intake, needs assessment, and care planning procedures
• Coordination of healthcare, social, and community-based services
• Crisis intervention and emergency response protocols
• Staff credentialing, background checks, and ongoing training records
• HIPAA compliance, participant rights, and grievance handling
• Documentation standards for service coordination and Medicaid billing
• Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Case Management Program Director
Requirements: Bachelor’s or Master’s degree in social work, human services, or healthcare, certification in case management preferred, supervisory experience

Role: Case Managers
Requirements: Bachelor’s degree in social work, healthcare, or a related field, experience in care coordination and service planning, background clearance.

Role: Case Management Assistants
Requirements: High school diploma or GED, experience in administrative support and data entry, background clearance.

All staff must complete:

• Training in person-centered planning and case management practices
• HIPAA compliance and participant rights education
• Crisis management and de-escalation techniques
• Annual competency evaluations and continuing education
• Ongoing training in service coordination and resource management

7. MEDICAID WAIVER PROGRAMS

Case Management Services are available under the following Nevada Medicaid Waivers:

• Home and Community-Based Waiver for Persons with Intellectual and Developmental Disabilities (HCBS-IDD)
• Frail Elderly (FE) Waiver
• Physical Disabilities Waiver
• Traumatic Brain Injury (TBI) Waiver
• Aged and Disabled (AD) Waiver

Services may include:

• Coordinating healthcare and supportive services
• Developing and monitoring Individualized Service Plans (ISPs)
• Assisting with accessing community resources and financial aid
• Crisis intervention and emergency coordination
• Providing advocacy and support for participant needs

8. TIMELINE TO LAUNCH

Phase: Business Formation and Compliance Preparation
Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development
Timeline: 2–3 months

Phase: Nevada Medicaid Provider Enrollment and Readiness Review
Timeline: 60–90 days

Phase: Medicaid Billing Setup and Case Management Service Launch
Timeline: 30–45 days

9. CONTACT INFORMATION

Nevada Department of Health and Human Services (DHHS)
Website: https://dhhs.nv.gov/

Aging and Disability Services Division (ADSD)
Website: https://adsd.nv.gov/

Nevada Medicaid Provider Enrollment Portal
Website: https://www.medicaid.nv.gov/

Centers for Medicare & Medicaid Services (CMS)
Website: https://www.cms.gov/

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10. SCOPE OF WORK

• Business registration, Medicaid enrollment, and licensing support
• Policy manual development for care coordination and crisis management
• Staff credentialing, training program templates, and documentation guidance
• Medicaid billing setup and audit-prepared financial management
• Branding, website development, and client engagement strategies
• Quality assurance systems for service coordination and compliance
• Collaboration with healthcare and community organizations for resource sharing

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NEVADA CASE MANAGEMENT SERVICES PROVIDER

We support agencies in launching Medicaid-compliant Case Management Services in Nevada.

To get started, click the link to request portal access