Provider Update: Conflict Free Case Management #2

Due to the implementation of the CMS rule regarding Conflict Free Case Management there is a new form (Attestations of Conflict Free Case Management)  required with all submissions of Reassessment Plans, change in Service Provider, or change in service(s). The new form is a statement attesting the Case Manager and Case Management Supervisor has assured the service request submitted is Conflict Free per CMS rule §441.301(1) (vi). The acknowledgement reads as follows;

I hereby confirm this service plan is in Compliance with CMS rule §441.301(1) (vi) regarding Conflict Free Case Management, which states in part, that “Providers of HCBS for the individual, or those that have an interest in or are employed by a provider of HCBS for the individual must not provide case management or develop the person-centered service plan….”

Effective August 1st, 2014 the Attestation of Conflict Free Case Management form will be required for all Service Plans submitted to the AA. Failure to submit the form with the required signatures will result in a delay in authorization of Case Management.  The Service Plan Authorization Unit (SPA) will be conditionally authorizing the T1016 Case Management line if the new form is not submitted with the Service Plan.

In addition, effective the same date, August 1st, 2014, all addendums submitted for a change in service provider or service addition(s), will be required to have the new form. Additionally, this form will not be available in our website’s Forms directory until a future time. Please save and distribute this form at your agency. In the event you need a copy of the form you may request it through the Provider Questions via Smarter Mail link provided at the bottom of this communication.
This change will be a part of the performance measures the AA is required to submit to CMS, thus requiring strict adherence to the rule change(s) and timelines. Failure to comply may result in an off referral basis and a corrective action plan request.

ALL SERVICE PLANS, REACTIVATIONS, TRANSFER ADDENDUMS, OR ADDITION OF SERVICE TO THE MEMBERS SERVICE PLAN;

Effective August 1st, 2014, All Service Plans and Addendums received out of compliance with the CFCM rule change will be conditionally authorized regardless of the service plan begin date. All home care lines will be authorized as appropriate. A condition will be placed on the T1016 Case Management service line stating, “Please educate Members on the CFCM rule and submit a Transfer Addendum for either Case Management, Home Care, or both as Members select”.

Effective October 1st, 2014, the T1016 Case Management service line will NOT be authorized until the plan is in compliance with the CFCM rule. The Home Care lines and all other Advantage services will be authorized as appropriate.

For Service Addendums requiring an increase or addition of services with a currently authorized provider, the attestation form will not be required. An example would be an increase of personal care or addition of skilled nursing from the current Home Care Provider agency. The AA recognizes there may be a current conflict existing until a transfer or reassessment Service Plan is completed.

Case Managers will continue to be responsible for ensuring service delivery to Members is not affected due to the status of the Case Management service line. As stated above, a condition will be placed on the T1016 directing Case Managers to educate Members on the CFCM rule.

Please note: Case Managers will be required to submit justification for service providers being out of compliance with the new Rule in order for Case Management services to be authorized for the timeframe required to bring the plan into compliance.

UPDATE- THERE WILL BE NO CHANGE IN STANDARD NAMING CONVENTION

Due to the stringent time frame for this implementation, use of the alphanumeric naming convention will not be initiated. The Case Management agencies will be responsible for assuring the Conflict Free Case Management rule is applied as directed in the previous section.

If you have any questions regarding the information provided above, please feel free to contact us via Smarter Mail at:  aauproviderquestion@aau.okdhs.org