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Important Webinar on Conflict of Interest Requirements for NHTD and TBI Providers

As the Traumatic Brain Injury (TBI) and Nursing Home Transition & Diversion (NHTD) waivers transition into managed care, new Conflict of Interest (COI) requirements established by the Centers for Medicare and Medicaid Services (CMS) are being implemented in accordance with the HCBS settings rule. As you may know, the rule ensures that individuals receiving long-term services and supports through HCBS programs under the 1915(c), 1915(i), and 1915(k) Medicaid authorities have full access to benefits of community living and the opportunity to receive services in the most integrated setting appropriate.

In conjunction with the rule, CMS has identified potential Case Management COI practices that will be prohibited. LeadingAge NY has voiced concern to DOH about the requirements and has been advocating for flexibility on behalf of plans and providers. COI practices of concern include the same entity providing case management and/or service coordination for a person while providing services to that individual, the same entity overseeing quality and outcomes of services rendered to the participant, the same entity having a “fiduciary” relationship with the provider of services, or the same entity functioning in a position that may influence the participant’s free choice.

CMS will be requiring TBI and NHTD providers to develop an implementation plan to ensure compliance with these new requirements. DOH must meet full compliance regarding this issue by Jan. 1, 2019, and CMS has agreed to the implementation of interim compliance measures until that date. DOH’s corrective action plan establishes that each waiver provider will submit a compliance plan to DOH.

An informational webinar will be held on Tues., Jan. 9, 2018 from 10:30 am to 12:30 pm and is not an in-person event. DOH will explain the development and submission of the compliance plans. Questions will be addressed via the chat box and will be followed up with posted frequently asked questions (FAQs).

To register, click here.

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