1. Conflict Free Case Management
History
HB-1343
Timeframes
Options

2. What is the perceived conflict?
People receiving Home and Community Based Services (HCBS) under the Medicaid Program receiving Case Management (CM) and Direct Services from the same agency
Perception of limited choice
RFP Process
Only referring to their own agency
Federal regulation in 2014 requiring separation of CM and Direct Services

3. Conflict Free Case Management (CFCM)
CMS issued conflict of interest requirements in the rule for 1915(c) Home and Community Based Services (HCBS) waivers:
Requirements at 42 CFR (c)(1)(vi)
Per CMS, States are required to separate case management (person-centered service plan development) from service delivery functions1
Conflict occurs not just if an entity is a provider, but if the entity has an interest in a provider or is employed by a provider 1
1 This information is from CMS training titled “Conflict of Interest Rules in Medicaid Authorities”, which was conducted by CMS on January 13, 2016.

4. House Bill 17-1343: Definitions
Community Centered Boards:
Eligibility Determination
Administrative Functions
Human Rights Committee (HRC)
Supports Intensity Scale Assessment (SIS)
Investigations
Mistreatment, Abuse, Neglect, Exploitation (MANE)
Early Intervention – Individualized Service Plans
Refer to Case Management Broker
Case Management Broker:
Helps people choose a Case Management Agency (CMA)
Possible option: Regional Accountable Entity (RAE)
Case Management Agency:
Intake and Assessment
Develops Service Plans
Helps people choose a Provider Agency
Provide Targeted Case Management Services
Options:
Current CCB
Another CCB
A non-CCB CMA

5. House Bill 17-1343: Definitions
Business Continuity Plan
Specifically how will Envision come into compliance with CFCM
Options
CCB
CMA
Provider Agency
Cease Operations
Fiscal Impacts of options
Community Impacts of options
Timeframes
Decision deadline
Draft
Final
Submit to HCPF
Provider Agency
Provides HCBS waiver direct services and supports
Supports individuals in obtaining what is important to and important for them
Cannot be the Case Management Agency for the person receiving direct services

6. Timeframes – Subject to Change
6/2017: HB was signed by the Governor
1/1/18: HCPF Rules should be published
7/1/18: CCBs must submit Business Continuity Plan (BCP)
6/30/19: HCPF analysis of expenses/impacts
6/30/20: CCBs must complete business operation changes
6/30/21: 25% of all people served must be through a conflict-free system
6/30/22: All people served must be through a conflict-free system

7. Four Options
Continue providing Case Management and Direct Services, but not to the same person
Become a Case Management Agency
Become a Service Provider Agency
Don’t do either and go out of business

8. Envision by the numbers
Medicaid Waiver DD percentage not served by Envision PS: 59%
Medicaid Wavier SLS percentage not served by Envision PS:76%
State SLS percentage not served by Envision PS: 75%

9. Sample Fiscal Impact Considerations
Facility costs
Shared Administrative Functions
Fleet lease obligations
Operating lease obligations
Unemployment insurance claims due to possible staff layoffs
Business insurance costs
Employee benefit costs
less employees higher costs

10. Employee Count by Department
Administration 12
Adult CM
Children’s CM
Program Services 105
Excluding Crew 61
Crew 44
Total Employees 151

11. Questions and Comments