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Provider Update: Conflict Free Case Management #4

August 5, 2014

Clarification on Medicare and Medicaid (CMS) Final Rule Implementation

As everyone is aware, the CMS new Final Rule was released this spring, a key focus of which has been the matter of Conflict Free Case Management. The Oklahoma Department of Human Services Aging Services (DHS-AS) held a meeting with providers on June 25th as well as releasing three (3) bulletins on the matter (June 10, July 2, and July 23). A number of providers are already falling into compliance and we are grateful. 

In revisiting the initially proposed timeline with the Oklahoma Health Care Authority (OHCA), they stressed that non-compliance with the final rule may cause loss of federal funding.  So beginning today, please continue working with the ADvantage Administration team to bring service plans into compliance as soon as possible.

Also for clarification, all ADvantage service codes for Home and Community Based Services are included in the Conflict Free Case Management scope. This means a Member receiving Case Management from one service provider may not receive any other ADvantage service from any provider with an interest in the same Case Management Provider agency (following conflict of interest guidelines).

These service(s) include, but are not limited to;

  • Durable Medical Equipment and Specialized Medical Supplies (all associated service codes, includes all incontinence supplies)
  • Adult Day Health (S5100(U1), S5105(TG)(U1))
  • All Home Care Services (includes all nursing, personal care and respite services) (T1002, G0154(TF), T1019(TF), T1005, S9125)
  • Hospice (S9126)
  • Physical Therapy (G0151)
  • Occupational Therapy (G0152)
  • Speech Therapy (G0153)
  • NF Extended Respite (UB120)
  • PERS (Personal Emergency Response System and Monitoring) (S5160, S5161)
  • Home Delivered Meals (S5170)
  • Assisted Living Services (all associated Service Codes)
  • Environmental Modifications (S5165)

If you have any questions regarding the information provided above, please feel free to contact us via Smarter Mail

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