1. Program Definition and Services

Case Management Services (often referred to as Service Coordination or Care Management in New York state initiatives) provide short-term and ongoing coordination support to children and adults with intellectual, developmental, physical, or chronic disabilities. The program aims to help maintain individuals with disabilities in the community, averting the need for long-term institutional services and supports. Services include:

• In-Home Case Management: Individual coordination support, person-centered plan formulation, and resource linking in the individual/family home or community.
• Residential Care Coordination Tracking: Comprehensive oversight, care transition planning, and service monitoring within licensed residential or community-based settings.

2. Regulations

The program is governed by the following regulations:

• New York Codes, Rules and Regulations, Title 14, Part 635 (Rule 635)
• New York Codes, Rules and Regulations, Title 14, Part 636 (Person-Centered Planning and Life Plan Requirements)
• Mental Hygiene Law (MHL Articles 16 & 33)
• Social Services Law (Protection of People with Special Needs)
• Child Protective Services Act (State Central Register Reporting)

3. Licensing or Certification

Providers must be certified/designated by the New York State Department of Health or partner state agencies and strictly follow all Home and Community-Based Services (HCBS) federal and state requirements.

4. Responsible State Agency

The Office for People With Developmental Disabilities (OPWDD) and the New York State Department of Health (NYSDOH) are jointly responsible for reviewing applications, issuing designations, and certifying case management/care coordination service providers.

5. Application Process

The application process is conducted through the electronic New York Medicaid Provider Enrollment Portal (eMedNY). Providers must submit specialized provider enrollment forms online to initiate the official review process.

6. Required Documentation

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

• Proof of compliance with state safety, conflict-free case management, and operational rules
• Agency policy and procedure manuals (including intake and assessment frameworks)
• Staff qualifications, background screenings, and professional training records
• Proof of general and professional liability insurance

7. Timeline for Approval

The exact timeline for approval fluctuates based on state agency capacity and specific waiver designation workflows. Providers should contact their regional office or specific waiver designation team for detailed information on current processing timeframes.

8. Pre-Application Process

Prospective providers must complete specific foundation tasks before applying. They must officially establish their business entity with the New York Department of State and secure necessary federal identification numbers (EIN and NPI Type 2).

9. Pre-Application Training

The state hosts mandatory administrative, compliance, and billing systems training sessions online. Access details are sent to qualified applicants once preliminary enrollment paperwork is reviewed and accepted.

10. Additional Notes

• Providers must ensure that case management administrative spaces meet all state accessibility and environmental safety guidelines
• In-Home Case Management must be provided directly by the certified agency's qualified, employed personnel
• All service coordination and direct tracking staff must clear mandatory background checks, criminal history screenings, and fingerprinting protocols
• Providers must maintain detailed records of face-to-face case management contacts and updated electronic care plans for Medicaid documentation and audit compliance

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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