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Service Coordination Conflicts of Interest

The Department of Health (DOH) on July 7th sent an email to Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion (NHTD) waiver stakeholders stating that “effective April 1, 2018, any Service Coordinator or Service Coordination Provider agency will be restricted from providing any other waiver services unless the State demonstrates that the provider meets the exemption standards for rural and/or cultural accommodations.” The DOH waiver unit is currently identifying regional waiver service capacity and will be conveying its findings to the Centers for Medicare and Medicaid Services (CMS).

According to the DOH email, this restriction is necessary in order for the Department’s pending TBI/NHTD waiver applications to be approved by CMS. Conflict of interest (COI) language was part of the HCBS federal rule, and CMS has determined that when the same entity helps an individual gain access to services and provides services to that individual, there is a COI or the potential for COI. DOH has to submit a Corrective Action Plan (CAP) that is necessary to ensure compliance with the federal regulation, and this is a separate and distinct process from the waiver renewal. DOH has stated that in order for the pending TBI and NHTD waiver applications to be approved by CMS, an approved CAP is required, and the waiver application must include language confirming the CAP approval.

As you know, the TBI waiver is on a 45-day extension until July 23, 2017, and the NHTD waiver application is approved under temporary extension until Aug. 20, 2017. Please note that the transition of both waivers was postponed as part of the budget negotiating process until January 2019.

This is a strict interpretation of the COI provision, and this impacts 1915(c) waivers as well as the 1115 waivers. This interpretation would require separate case management (person-centered service plan development) from service delivery functions.

LeadingAge NY is analyzing this COI interpretation and will be submitting a response in writing to DOH.

Questions regarding this process can be sent to tbi@health.ny.gov.

LeadingAge NY will keep members posted on any further developments.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871