DOH Hosts NHTD/TBI Stakeholder Call with CMS

The Department of Health (DOH) and stakeholders of the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) programs held a group call with the Centers for Medicare and Medicaid Services (CMS) in mid-May to discuss various models of Conflict of Interest (COI) compliance relating to the federal Home and Community-Based Services (HCBS) rule. 

Under the COI requirement, providers of HCBS for an individual – or those who have an interest in or are employed by a provider of HCBS – must not provide case management (i.e. Service Coordination) or develop the person-centered service plan for that person, except when the only willing and qualified entity to provide case management and/or develop person-centered service plans in a geographic area also provides HCBS. In this instance, an entity would have to place firewalls between the two provider roles to ensure compliance with the rule.

Currently, much of the NHTD/TBI program is integrated with entities providing both Service Coordination and Home and Community Support Services (HCSS).

DOH and stakeholders presented and discussed the following COI models with CMS:

1. Service Coordination Separation Model – Allows entities to provide both Service Coordination and waiver services, but not both to the same person.
2. Plan Development and Service Oversight Model – Service Coordination role is redefined into two separate roles. Plan development agency develops initial, revised, and addenda to service plan; service broker identifies providers for the individual that are conflict-free, ready, and willing.
3. Statewide Organization Model – A statewide organization provides Service Coordination only.
4. Passive Parent Model – Passive parent holds two separate and distinct entities. One provides Service Coordination and the other waiver services, with firewalls in place.

LeadingAge NY and other providers expressed concern that implementation of the requirement would cause capacity issues for the NHTD/TBI program. Providers that deliver both Service Coordination and HCSS have communicated that Service Coordination is not sustainable as a separate business line without HCSS to balance out the cost of services. There is concern that access to Service Coordination would be very limited. In the very least, compliance would result in most waiver participants having to obtain new Service Coordinators or HCSS providers. The Department has acknowledged the potential lack of capacity and disruption this may cause to both providers and participants and intends to study access and minimize disruption as the program undergoes this change.

CMS was engaged in the conversation with stakeholders but was ultimately dismissive of Models B and D, which were presented by members of the provider community. Both DOH and CMS are eager for New York State to decide upon a compliance model, as implementation will require a lot of time, planning, and effort. CMS expects DOH to present its compliance model by June 1^st. COI requirements need to be in place for the NHTD and TBI programs no later than Jan. 1, 2021.

The PowerPoint presentation from the meeting is available here. Questions and comments may be submitted to DOH at waivertransition@health.ny.gov.

Please let me know if you have questions or concerns about this matter, particularly as they affect delivery of or participant access to services.

Contact: Meg Carr Everett, meverett@leadingageny.org, 518 867-8871