1. GOVERNING AGENCIES

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

Agency: Developmental Disabilities Program (DDP) within DPHHS
Role: Oversees service quality, participant protections, 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 offer comprehensive care coordination and planning for individuals needing long-term support, helping them achieve and maintain their highest level of independence.

Approved providers may deliver:

• Service Coordination: Linking individuals to medical, behavioral, and social services
• Care Planning: Developing and monitoring Individualized Service Plans (ISPs) to meet participants' needs and preferences
• Resource Access: Assisting with the application process for healthcare, housing, and community resources
• Advocacy: Ensuring individuals’ rights and preferences are respected during care planning and service delivery
• Crisis Intervention: Coordinating immediate care and support during emergencies
• Ongoing Monitoring: Regularly reviewing the effectiveness of services and making adjustments as needed

All case management must be delivered according to the participant’s ISP and comply with Medicaid waiver guidelines.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register the business entity with the Montana Secretary of State
• Obtain EIN from the IRS and NPI (Type 2)
• Enroll as a Medicaid Waiver Case Management provider via the Montana Medicaid Provider Enrollment Portal
• Maintain general liability and professional liability insurance
• Develop policies for care planning, documentation, participant rights, and emergency response
• Ensure staff meet background checks, health screenings, and relevant training requirements

4. MONTANA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Complete the Provider Enrollment Application through the Montana 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 service policy manuals

Program Readiness Review:

• DPHHS reviews provider readiness, including staff qualifications, care coordination protocols, and documentation systems

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for Case Management Services using assigned billing codes

5. REQUIRED DOCUMENTATION

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

Case Management Services Policy & Procedure Manual including:

• Intake, assessment, and service planning procedures
• Crisis intervention and emergency response protocols
• Advocacy, resource linkage, and care coordination guidelines
• Documentation standards, HIPAA compliance, and participant rights policies
• Staff credentialing, background checks, and continuing education records
• Medicaid billing procedures and audit readiness

6. STAFFING REQUIREMENTS

Role: Case Management Program Director
Requirements: Bachelor’s degree in social work, human services, or healthcare, experience in care coordination preferred, supervisory experience beneficial.

Role: Case Managers
Requirements: Bachelor’s degree in social services or related field, training in care planning, crisis intervention, and Medicaid service coordination, background clearance.

All staff must complete:

• Training in person-centered planning and service coordination
• HIPAA and confidentiality training
• Crisis management and advocacy training
• Annual continuing education and competency evaluations

7. MEDICAID WAIVER PROGRAMS

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

• Comprehensive Waiver for Individuals with Developmental Disabilities
• Community Supports Waiver for Adults with Physical Disabilities
• Big Sky Waiver (Aged and Disabled)
• Traumatic Brain Injury (TBI) Waiver
• Children's Autism Waiver

Services may include:

• Service planning and coordination
• Advocacy and resource linkage
• Crisis intervention and follow-up
• Ongoing service monitoring and evaluation

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: Montana 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

Montana Department of Public Health and Human Services (DPHHS)
Website: https://dphhs.mt.gov/

Developmental Disabilities Program (DDP) — DPHHS
Website: https://dphhs.mt.gov/dsd/developmentaldisabilities

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

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10. SCOPE OF WORK

• Business registration, Medicaid enrollment, and compliance preparation
• Policy manual development tailored to case management practices
• Staff training programs, credentialing templates, and care coordination protocols
• Medicaid billing system setup and claims management
• Website, branding, and outreach strategies
• Incident reporting, documentation standards, and quality assurance measures
• Networking strategies to connect with healthcare and community resources