Case Management System

Integrated case management and service coordination systems, hosted by the state, available to replace legacy and paper systems, streamline accommodation and individualized service plans and ensure adherence to Centers for Medicare and Medicaid Services (CMS) regulatory guidance and reporting while ensuring data privacy.
- The comprehensive system will include Client Intake, Eligibility, and Profile Management, Case Management and Service Planning, Document and Medical Records Management, Billing and Financial Integration, Quality Assurance and Tracking, and Federal Reporting Support.
- Client Intake, Eligibility, and Profile Management
o Configure centralized digital client charts that contain information and forms such as demographics, guardianship/legal status, diagnostic history, and psychological evaluations.
o Digitize and migrate existing historical paper charts, assessments, eligibility determinations, and all other relevant information
o Establish a customized file plan and taxonomy matching South Dakota specific I/DD regulatory requirements
o Allow profiles to move between billing, locations, and service providers as well as funding sources.
o Include integration of assessments for eligibility determinations, level of care determinations, assessment scoring, and use workflows to manage processes.
o Management of waitlists, and referrals to case management workflows.
- Case Management and Service Planning
o Support the creation of Individual Support Plans (ISP) and Person-Centered Plans (PCP) that are relevant to the waiver utilized.
o Link ISPs and PCPs to daily progress monitoring. Real-time mobile-first notes, incident reports, and structured data collection that support outcome measurement
o Link documentation of behaviors to outcomes
o Configure custom rating scales, milestones, and behavioral frequency/duration/intensity tracking tools for all case manager and providers
o Provide program-level outcome reporting dashboards to evaluate longitudinal progress against personal goals
o Coordinate person-centered planning with housing, employment, and other services
o Integration of self-direction coordination including the creation and management of participant budgets that either integrate with established Financial Management Systems (FMS) or can function as an FMS.
o All case notes, documentation, individualized support plans, and other aspects must be compliant with federal and state regulations and CMS requirements.
- Document and Medical Records Management
o Implement electronic medication administration records (eMAR) and e-prescribing integration
o Centralize tracking for vital signs, immunizations, dietary/swallowing protocols, and health appointments
o Allow other medical information to be entered and tracked such as nursing, therapy notes, or dietary and nutritional information
o Provide structured behavior tracking workflows with automated alerts routing to appropriate users
o Allow creation, entry and tracking for behavior support plans with workflows for tracking and automated alerts
o Allow documentation to be attached when necessary for aspects that are not paperless. The documentation must be centralized and accessible based on role.
- Billing and Financial Integration
o Interface with MMIS and other external systems to track both billing claims and eligibility
o Build staff scheduling tools matching client acuity, required staff-to-individual ratios, and specialized skill sets across shifts/sites
o Creation and entry of service authorizations at the end user level with workflows that route for Division approval
o Integrate or embed electronic visit verification (EVV) capturing real-time GPS/Timestamp data compliant with state Medicaid mandates
o Montior authorized service units live, generating automated warning alerts ahead of authorization caps or expiration gaps
o Implement claims automation validating direct support providers service notes against active authorizations prior to claim submission
o Directly link service plan documentation to claims process
o Support Multi-payer architectures (Medicaid Waivers, private contracts, etc.)