DOH Proposes Conflict of Interest Implementation Plan for NHTD/TBI Waiver Programs

Recently, the Department of Health (DOH) held a meeting to put forth a plan regarding Home and Community-Based Services (HCBS) Conflict of Interest (COI) implementation for entities providing both Service Coordination and waiver services for the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Programs. DOH has posted their slides, entitled "COI Next Steps" – Aug. 9, 2019, on their website.

DOH is proceeding with a model that allows entities to provide both Service Coordination and waiver services as long as the same participant is not receiving both from the same entity. Entities will still be able to provide either service as is currently the case. This COI provision will not apply to exempt services listed in the slides, which, among other things, relate to assistive technology, home modifications, moving and transition services, and environmental modifications.

DOH is looking at their NHTD provider/participant claims data and trying to pinpoint where working partnerships among providers might be established that would allow entities to offer services so that capacity remains intact throughout the state. Many providers had indicated that if they could not do both, they would likely drop Service Coordination. DOH said that they would push out this data to individual providers by the first week of September and would like feedback on how entities might plan to comply with the COI provisions. All providers should look at their numbers to confirm accuracy and provide feedback, concerns, and questions on potential compliance.

The Department indicated during the meeting that the data shows that a geographical exemption would likely not be available anywhere in the state due to at least two providers of a service being available in every region. LeadingAge NY plans to inquire more about this, as there might be some instances where capacity might still be an issue and/or capability issues might come into play where one provider is preferred. Perhaps situations like this could be clarified in policy or adjudicated in fair hearing.

The Department is seeking input, and stakeholders are encouraged to share their concerns, questions, and thoughts. They have acknowledged that feedback from business, clinical, and operational perspectives is critical to a smooth transition. DOH stressed that this is a draft model and that all stakeholders are needed to develop this implementation plan.

DOH also proposed some programmatic changes to ease the transition:

• Continue efforts to expand the number of Service Coordination providers
• Staff Qualifications – Grandfather existing staff as they transfer to new employers (which is prohibited under recent regulatory changes)
• Add additional staff qualifications and changes to experience requirements for several provider roles for both the NHTD and TBI waivers, including Service Coordination, Community Integration Counseling Services (CIC), Positive Behavioral Interventions and Support Services (PBIS), Independent Living Skills Training Services (ILST), and Program Director for Structured Day Program Services (SDP). See slides for specifics.

Again, DOH is seeking your thoughts on these changes as well as any other policy or program changes that might aid in maintaining capacity and services and developing workforce capacity during the COI transition. Many of the stakeholders had recommendations for DOH, some of which included increases to reimbursement rates. While this COI implementation process will be daunting, it is an opportunity to shape the waiver programs in other ways.

Please take a close look at the slides and think of your hiring practices, capacity issues, relationship with your Regional Resource Development Center (RRDC), and other aspects of your program that might help shed some light on the direction the Department should take with this process. At any time, providers and participants can submit questions and comments to waivertransition@health.ny.gov.

LeadingAge NY will be holding a conference call to solicit feedback from members on this proposal. Please contact me if you are interested in joining.

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