Update on Conflict of Interest in NHTD/TBI Waiver Programs
The Department of Health (DOH) held a webinar last week for Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Waiver providers to provide an update on implementation of Conflict of Interest (COI) requirements under the Home and Community-Based Services (HCBS) Rule.
The Centers for Medicare and Medicaid Services (CMS) recently extended the COI compliance deadline to March 1, 2024. As providers know, the COI rules prohibit entities from providing both Service Coordination (SC) and waiver service to the same individual. Entities may provide both types of services, but not to the same individual. CMS has provided additional flexibility to waiver participants when they are finding it difficult to obtain providers by allowing an “only willing and qualified provider” policy.
Implementation of the “only willing and qualified provider” protocol:
- Service plan contains both direct services and SC from the same provider
- Service Coordinator will contact the Regional Resource Development Center (RRDC) to indicate that a conflict exists
- RRDC will supply provider lists for the services in conflict (SC and one or more direct services)
- Service Coordinator will explain the provider selection process and give the provider lists to the participant
- If a new provider is found, plan can be approved
- If no new provider can be found, the participant signs an attestation to that effect
- New provider selection forms are completed for the services in conflict
- Plan is submitted to the RRDC for review and approval
- Approval is granted for one year, and repeated annually
Entities granted this status for participants and providing both services to the same individual must follow significant firewall requirements as clarified in past presentations. Many queries were posed regarding the patient’s right to choose their provider. DOH emphasized that the beneficiary is obligated to switch providers if there is one available.
DOH reviewed protocols for termination of a waiver service or transfer to another waiver provider and noted that the procedures remain unchanged.
As covered in past presentations, any service plan approved before March 1, 2024 does not have to show COI compliance. Any service plan approved after March 1st must be fully compliant. This includes amended service plans.
Providers can email the Department if their questions were unanswered during the live session. The slides will be distributed to attendees and posted on the Department’s website. The webinar was not recorded. LeadingAge NY will share the Frequently Asked Questions (FAQ) document if one is provided.
Please feel free to reach out if you have questions.
Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871