Case Management Services in Indiana provide comprehensive coordination of services and supports for individuals receiving long-term care under Medicaid. These services help participants navigate resources, ensure service quality, and promote independence. Case Management is authorized under Indiana Medicaid Home and Community-Based Services (HCBS) Waiver programs and certain State Plan programs.

1. GOVERNING AGENCIES

Agency: Indiana Family and Social Services Administration (FSSA) — Division of Disability and Rehabilitative Services (DDRS) and Division of Aging
Role: Oversees Case Management Services under HCBS waiver programs, including provider enrollment, service monitoring, and participant protections

Agency: Indiana Office of Medicaid Policy and Planning (OMPP)
Role: Administers Medicaid reimbursement for Case Management Services and manages provider enrollment and claims processing

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Provides federal oversight ensuring Medicaid-funded Case Management meets HCBS Settings Rule, person-centered planning, and conflict-free care coordination requirements

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2. CASE MANAGEMENT SERVICE OVERVIEW

Case Management Services assist participants in accessing medical, behavioral, social, educational, and community resources. Case managers work closely with individuals and their support networks to develop and monitor person-centered service plans.

Approved providers may deliver:

• Comprehensive assessments of needs, risks, and strengths
• Development of the Individualized Support Plan (ISP) or Person-Centered Service Plan (PCSP)
• Coordination of waiver and non-waiver services (e.g., housing, employment, education)
• Ongoing monitoring to ensure service quality and effectiveness
• Advocacy for participant rights and support in making informed decisions
• Transition support (e.g., from institutional care to home/community settings)

All services must be conflict-free, meaning providers cannot deliver direct waiver services to participants they case manage.

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business entity with the Indiana Secretary of State
• Obtain EIN from the IRS and NPI (Type 2)
• Enroll as a Medicaid Case Management provider through the Indiana Medicaid Provider Enrollment Portal
• Ensure conflict-free status by not providing other HCBS waiver services to the same participants
• Maintain general and professional liability insurance
• Develop policies for assessments, service planning, participant monitoring, documentation, and emergency response
• Ensure all staff meet educational and training standards required for Medicaid case management

4. INDIANA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Submit Provider Enrollment Application via Indiana Medicaid Provider Portal for HCBS Case Management Services

Application and Documentation Submission:

• Provide Articles of Incorporation, EIN/NPI confirmation, conflict-free attestation, staff credentials, insurance certificates, and operational policy documents

Program Readiness Review:

• FSSA reviews provider qualifications, conflict-of-interest safeguards, documentation systems, staff training, and participant protections

Approval & Medicaid Enrollment:

• Upon approval, providers receive authorization to bill Medicaid for assessments, service plan development, monitoring visits, and coordination services

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5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License
• IRS EIN confirmation
• NPI confirmation
• Proof of general and professional liability insurance
• Conflict-Free Case Management attestation

Case Management Policy & Procedure Manual including:

• Intake, comprehensive assessment, and person-centered planning procedures
• Risk mitigation, service authorization, and emergency response protocols
• Ongoing service monitoring and documentation standards
• Participant rights, HIPAA compliance, and grievance resolution procedures
• Staff credentialing, training, and supervision records
• Medicaid billing and audit-ready service documentation protocols

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6. STAFFING REQUIREMENTS

Role: Case Management Supervisor / Program Director
Requirements: Bachelor’s or Master’s degree in social work, psychology, nursing, education, or a related human services field; experience in supervision and waiver services; background screening clearance

Role: Case Managers / Support Coordinators
Requirements: Bachelor’s degree in human services or related field; completion of person-centered planning training; experience working with people with disabilities or aging populations preferred; background screening clearance

All staff must complete:

• HCBS Settings Rule and person-centered service planning training
• Conflict-free case management training
• Abuse prevention, emergency procedures, and participant safety training
• HIPAA compliance and confidentiality training
• Annual continuing education and competency reassessments

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7. MEDICAID WAIVER PROGRAMS

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

• Community Integration and Habilitation (CIH) Waiver
• Family Supports Waiver (FSW)
• Aged and Disabled (A&D) Waiver
• Traumatic Brain Injury (TBI) Waiver

Approved providers may deliver:

• Initial and ongoing comprehensive assessments
• ISP development, updates, and documentation
• Coordination of waiver and community-based services
• Ongoing participant support and monitoring visits
• Crisis planning and transition services

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8. TIMELINE TO LAUNCH

Phase: Business Formation, Conflict-Free Compliance, and Program Setup
Timeline: 1–2 months

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

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

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

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9. CONTACT INFORMATION

Indiana Family and Social Services Administration (FSSA) — DDRS & Division of Aging
Website: https://www.in.gov/fssa/

Indiana Medicaid Provider Portal
Website: https://www.in.gov/medicaid/providers/

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

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10. SCOPE OF WORK

• Business registration, conflict-free provider compliance setup, and Medicaid enrollment support
• Development of Case Management Services Policy & Procedure Manual
• Staff credentialing templates, participant assessment tools, and service plan documentation systems
• Medicaid billing system setup and audit-ready service tracking support
• Website, domain, and professional branding setup
• Quality assurance programs for documentation audits, satisfaction surveys, and participant rights protections
• Strategic partnership development with waiver case managers, medical providers, and social service agencies