Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
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5/19/23  9:28 am
Commenter: Anonymous

TCM BI Draft feedback

Please clarify what is considered "conflict of interest" (COI) in providing services.  In the draft it states the following:

"Pursuant to 42 CFR 441.301(c)(1)(vi), providers of HCBS for the individual, or those who 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 plan of care, except when the State demonstrates that the only willing and qualified entity to provide case management and/or develop person-centered plan of cares in a geographic area also provides HCBS.  In order to meet this requirement an individual that provides case management services must not be employed (directly, or as a contractor) by an entity that provides other HCBS services.  Furthermore, an individual or entity that provides case management/support coordination services must not have an interest (as defined in 42 CFR 411.354) in a provider of other HCBS services."  

Throughout the development of these services the stance has been that an agency can't provide TCM services and waiver services.  In our most recent meeting with DMAS what was communicated was that an agency could provide both TCM and waiver services however they couldn't be the provider of both to the same individual.  

These are two very different stances which affect services among existing providers.  Clarification is needed.  


CommentID: 217015