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New Conflict‑Free Case Management: Department Says 15% of Cases Needed Exceptions in Early Rollout
Summary
The department told legislators that the conflict‑free case management rollout for developmental disabilities produced exceptions in about 15% of cases (as projected) and that the department has processed exception requests; a detailed report is due Feb. 15 with further determinations in March.
Department witnesses described the October rollout of conflict‑free case management and a new standardized needs assessment tied to funding tiers. Staff said the design anticipated an exception rate and that early data matched projections.
"This is exactly on target," one division official said, recounting department projections for exceptions under the new model. Officials reported 460–465 exceptions were expected in the second quarter (about 15% of cases) and that an initial portion requested exceptions; the department later reported all expected exceptions had been entered into the process.
Agency staff described the exception review as an administrative process that includes justification of higher funding when an individual’s assessed needs exceed the standard tier amount. The department said most exception requests are being approved and that the process allows individuals to request adjustments if their assessed services exceed the tiered maximum.
The department committed to provide the committee with a full report on payment‑reform implementation on Feb. 15 and follow‑up materials in March. Staff said March timelines will include determinations about provisional statuses for providers and potential next steps if remediation is insufficient.
Committee members asked for historical comparators and whether the observed exception rate represents a disruption versus normal operations; department staff said the 15% projection was expected as part of moving from a non‑standardized system to the new tiered model.
