1. Program Definition and Services
Case Management Services, also known as Targeted Case Management (TCM) or Service Coordination, provide specialized advocacy, programmatic evaluation, and resource orchestration for children and adults with intellectual/developmental disabilities, complex medical conditions, or advanced aging limitations. Operating as a strict, conflict-free administrative gateway, this program coordinates local clinical and social supports to ensure participants live safely in their private residences, actively preventing unnecessary nursing home or institutional placement. Services include:
- In-Home Personal Care (Assessment & Action Planning): Executing direct, person-centered casework evaluations inside the client's home (conducting comprehensive bio-psychosocial risk screenings, building individualized Services Backup Plans, coordinating hospital-to-home discharge pathways, and designing person-centered Individualized Service Plans [ISPs])
- Residential Personal Care (Monitoring & Provider Alignment): Managing ongoing community-facing logistics to anchor independent or supported residential placements (orchestrating multi-disciplinary interdisciplinary team [IDT] reviews, managing localized housing and food resource links, vetting specialized vendor choices, and delivering periodic face-to-face quality compliance visits)
2. Regulations
- Oklahoma Administrative Code (OAC) Rule 317:35-17-14 (ADvantage Waiver Case Management Mandates)
- Oklahoma Administrative Code (OAC) Section 317:30-5-971.1 (Targeted Case Management Definition and Standards)
- OAC Title 340, Chapter 100 (DDS Departmental Rules and Case Management Governance)
- Federal Conflict-Free Case Management Rules (42 CFR § 441.301(c)(1)(vi)
3. Licensing or Certification
Case management agencies do not operate under medical facility board licenses, but must secure formal Waiver Program Certification issued by the Oklahoma Department of Human Services (OKDHS) divisions (such as Developmental Disabilities Services [DDS] or Community Living, Aging and Protective Services [CAP]).
4. Responsible State Agency
The Oklahoma Health Care Authority (OHCA) administers SoonerCare (Oklahoma Medicaid), controls electronic processing loops, and establishes the medical necessity rules.
5. Application Process
Agencies first submit a comprehensive organizational qualification and training implementation plan to the appropriate OKDHS division for initial program certification. Following state validation, the entity applies for structural enrollment digitally via the electronic Oklahoma SoonerCare Provider Portal managed by the OHCA to formalize their Medicaid provider billing agreement.
6. Required Documentation
- Oklahoma Secretary of State corporate registration filings (Articles of Organization/Incorporation)
- Federal EIN and an Organizational Type 2 National Provider Identifier (NPI)
- Official OKDHS Case Management Agency Certification approval documents
- Comprehensive Case Management Policy and Procedure Manual (detailing conflict-free boundaries, emergency backup protocols, and UCAT assessment mechanics)
- Professional liability, commercial general liability, and mandatory workers' compensation insurance certificates
- Certified OSBI background checks and adult/child protective registry clearances for all coordinators
7. Timeline for Approval
The dual-tiered state evaluation and system setup cycle generally requires 3 to 5 months to complete, heavily contingent on individual coordinator training milestones, policy reviews by OKDHS, and backend system handshakes inside the SoonerCare portal.
8. Pre-Application Process
Before creating electronic state administrative profiles, companies must legally finalize their business entity via the Oklahoma Secretary of State portal, buy substantial professional liability coverage, open a distinct corporate operating bank account, and establish secure data systems capable of hosting protected electronic case files.
9. Pre-Application Training
All newly hired case management staff and supervisors must clear extensive state certifications before receiving client allocations. Candidates are required to successfully finish the mandatory DDS Foundations Training Modules or the ADvantage Case Management Core Curriculum and demonstrate clear mastery of the electronic Universal Comprehensive Assessment Tool (UCAT).
10. Additional Notes
- Under OAC 317:30-5-763, case management agencies are legally barred from delivering direct care services (such as personal care or home modifications) to the same participant, ensuring a complete separation of assessment and service delivery
- Once an ADvantage waiver referral is received from the state, the assigned case manager must complete the home evaluation and submit a signed, finalized person-centered service plan within ten (10) business days
- Coordinators must complete a face-to-face evaluation with the participant at least once per month (or as specified by waiver tiers) to systematically monitor service quality, safety conditions, and ISP efficacy
- Case management hours must be meticulously logged and billed in exact fifteen (15) minute increments, strictly accounting for direct client interactions or authorized advocacy tasks
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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