Conflict of Interest Deadline Extended for Waiver Providers
HCP connected with the Department of Health (DOH/the Department) on November 13, 2023, and learned that the deadline for the Conflict of Interest (COI) requirements in the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) programs has been extended until March 1, 2024.
Thanks to this timely approval by the Centers for Medicare and Medicaid Services (CMS), waiver providers now have several months to continue preparing for the COI requirements in the NHTD and TBI programs.
HCP verified with the Department that the extension applies to both programs.
Background
As previously reported in the HCP Insider, DOH recently applied to CMS requesting several amendments to the 1915(c) Waiver Programs.
HCP had noted in our previous report that DOH requested a COI extension for NHTD Service Coordination, but the TBI amendment contained no extension request. According to the Department, this was an error of omission which they will correct in the State Register. A Public Comment regarding this correction is being posted by DOH.
Regarding COI, the proposed amendments stated that the Department “continues to implement the steps necessary to transition service coordination functions to a structure that is compliant with Conflict of Interest (COI) standards.”
Conflict of Interest General Information
Both the TBI and NHTD proposed amendments include a DOH summary of the Conflict of Interest (COI) requirements. Service Coordination must be conflict-free and may only be provided by agencies and individuals employed by agencies who are not:
- Related by blood or marriage to the participant or any paid service provider of the participant.
- Financially or legally responsible for the participant.
- Empowered to make financial or health-related decisions on behalf of the participant.
- Sharing any financial or controlling interest in any entity that is paid to provide care for or conduct other activities on behalf of the participant.
- Employed by agencies paid to provide direct or indirect services (as defined by the Department) to the participant.
Furthermore, the COI requirements state that, “A provider entity providing direct services to an individual can only conduct service planning/case management for that individual when it is the only willing and qualified entity to do so.”
To help ensure provider compliance with COI guidance in both waiver programs, the Regional Resource Development Centers (RRDC) will be responsible for facilitating the steps necessary to implement COI standards with providers and participants.
Public Comment Period
The public may review and comment on the NHTD waiver amendment and the TBI waiver amendment. File comments electronically or mail them to: Department of Health, Office of Aging and Long-Term Care, Bureau of Community Integration and Alzheimer’s Disease, One Commerce Plaza, Suite 1610, Albany, NY 12210.
Comments must be emailed or postmarked by 30 days after the November 1, 2023, publication date. Be sure to include your name and affiliation. Those requiring special accommodation or alternate access may call (518) 474-5271 to access paper copies.