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KDADS lays out CMS conflict-of-interest compliance plan and one-year exception process
Summary
KDADS described how it will meet CMS rules that generally bar entities that develop service plans from also providing direct services to the same participant, including a PAT to draft safeguards and an exceptions process where CDDOs apply on behalf of providers for county-limited, one-year approvals.
KDADS staff described steps to align the Community Supports Waiver with Centers for Medicare & Medicaid Services (CMS) conflict-of-interest requirements and the exception process the agency plans to use where necessary.
Elian Sorensen said CMS prohibits entities or individuals responsible for service-plan development, monitoring, or implementation from delivering other direct waiver services to the same participant. KDADS is developing policy and processes to comply with that requirement and to allow limited exceptions when a provider is the only willing and qualified provider in a geographic area.
KDADS has convened a Policy Alignment Team (PAT) made up of providers, CDDOs, MCOs and other stakeholders to help draft an exception policy, monitoring and safeguards. Sorensen said the PAT is reviewing an exception policy that would require CDDOs to apply on behalf of affiliated providers; exceptions would be approved on a per-provider, per-county basis for one year with opportunities to reapply. KDADS will require documentation that the CDDO surveyed affiliated providers and found no willing and qualified alternatives; KDADS retains authority to investigate, approve or revoke exceptions and to require reporting and oversight.
Sorensen said the state must attest to safeguards when selecting the waiver-application option that permits exceptions, including full disclosure to participants, a clear dispute-resolution process for participants to challenge determinations, direct oversight and administrative separation of plan-development functions from direct-service delivery.
During Q&A, Debbie asked how KDADS would address applications where a CDDO is also a direct-service provider. Sorensen said KDADS will review applications closely, contact other providers as needed, and require attestations and supporting documentation; exceptions would not be approved if another willing and qualified provider affiliated with the CDDO exists. He emphasized the current priority is ensuring the CSW is conflict-free at launch; some IDD-waiver compliance questions will be addressed later.
