1. Program Definition and Services

Case Management Services (frequently designated as Care Coordination or Case Resource Management) in Washington provide centralized administration, clinical navigation, and systemic advocacy for individuals with significant cognitive, physical, or psychiatric functional limitations. Case managers serve as the foundational point of contact to ensure that vulnerable clients do not experience fragmentation of care. Services include:

• Assessment & Service Planning: Conducting localized functional eligibility assessments, mapping personal safety deficits, and authoring the mandatory Person-Centered Service Plan (PCSP)
• Resource Optimization & Monitoring: Coordinating direct cross-system referrals across medical, behavioral, vocational, and residential waiver domains while maintaining continuous face-to-face monitoring of client safety and service quality

2. Regulations

• Washington Administrative Code (WAC) Chapter 388-106: Establishes the regulatory definitions, assessment protocols, and functional service eligibility standards for long-term care and aging caseloads
• WAC Chapter 388-825: Formulates the overarching administrative and procedural frameworks governing services managed by the Developmental Disabilities Administration
• Title 182 WAC: Standardizes Health Care Authority (HCA) administrative laws relative to Apple Health Medicaid coverage, medical necessity verification, and provider reimbursement mandates

3. Licensing or Certification

Operating agencies do not hold a distinct facility license, instead, they must achieve formal administrative status as a Contracted Case Management / Care Coordination Agency via an executed master agreement with DSHS (ALTSA or DDA). To secure public funds, the agency must register within the HCA’s digital ProviderOne network under the appropriate specialized social service or case management provider taxonomy.

4. Responsible State Agency

The program is co-managed by three public entities: the DSHS Aging and Long-Term Support Administration (ALTSA) contracts for case management targeting older adults and individuals with physical challenges; the DSHS Developmental Disabilities Administration (DDA) manages internal and contracted specialized caseloads for individuals with intellectual disabilities; and the Washington State Health Care Authority (HCA) directs overall Medicaid policy and financial oversight.

5. Application Process

Applicants first secure corporate entity validation through the Secretary of State. The agency then submits an administrative credentialing and technical qualification proposal to the DSHS ALTSA or DDA regional contracts division. Once the state executes a formal social service waiver provider agreement, the agency enrolls in the ProviderOne portal to receive electronic client allocations and authorization paths.

6. Required Documentation

• Secretary of State business registration (UBI file), localized commercial occupancy permits, and a dedicated organizational Type 2 NPI
• Fully executed, active DSHS/ALTSA or DDA Specialized Care Coordination Master Contract
• A comprehensive Case Management Policy and Procedure Manual detailing strict PCSP auditing cycles, client crisis remediation workflows, HIPAA-compliant electronic logging, and language accessibility protocols
• Verified background check clearances processed through the DSHS Background Check Central Unit (BCCU) for all coordinators and agency principals
• Academic transcripts, professional degrees, and active licenses proving compliance with minimum workforce experience metrics
• Certificates of insurance confirming appropriate commercial general liability and professional liability protections

7. Timeline for Approval

Completing business structuring, securing professional tax accounts, and developing localized case tracking protocols requires 2 to 4 weeks. Technical contract evaluation by regional DSHS staff, background processing, and activation inside the ProviderOne electronic invoicing database typically spans 4 to 8 weeks.

8. Pre-Application Process

Prospective agencies must complete core structural setup operations before filing for state enrollment. They must legally incorporate through the Secretary of State, establish tax accounts with the Department of Revenue, obtain a federal EIN, and secure a Type 2 National Provider Identifier (NPI) indicating a specialized social work, case management, or care coordination taxonomy.

9. Pre-Application Training

While there is no multi-day pre-licensing academy required to file an application, all newly assigned case managers must complete state-mandated training modules (such as DDA or ALTSA baseline assessment courses) post-contracting. Onboarding personnel must hold valid credentials and complete orientation addressing mandatory abuse/neglect reporting, person-centered planning, and electronic documentation standards.

10. Additional Notes

• Academic Benchmarks: Under standard state procurement rules, individual case managers must hold a minimum of a Bachelor's degree in social work, psychology, human services, or a closely matching social science field, accompanied by at least one year of documented experience serving vulnerable populations
• The Enhanced Case Management Framework: Per DDA Policy 4.17, specific highly isolated clients or individuals residing in higher-risk settings are moved to the Enhanced Case Management Program (ECMP), which mandates stricter, more frequent face-to-face quality-of-care checks and specialized monitoring cycles
• The Direct Service Conflict Barrier: Under federal and state conflict-free case management rules, an agency authorized to deliver case management services is strictly prohibited from providing direct HCBS waiver paid services (such as home health care, personal care, or residential habilitation) to the same individual
• The 90-Day Visit Mandate: Depending on the specific waiver tier (such as Core or Basic Plus), case managers must perform face-to-face health, safety, and goal review visits with the client at least once every 90 days to keep the individual's waiver authorization active

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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