Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
Previous Comment     Next Comment     Back to List of Comments
6/8/23  1:27 pm
Commenter: Jason Young, Community Brain Injury Services

Conflict of Interest Clarification Needed

There have been several conflicting interpretation and guidance provided in the work group on how the Conflict of Interest provision is applied.  For the majority of the time the various workgroups were convened, we were told by DMAS, that a provider could not be a provider of Targeted Case Management and a provider of other HCSB services.   Our provider alliance was told to pick a lane as either a case management provider OR a provider of other HCBS services.   However, more recently, we have been told that the conflict of interest is related only specifically to the person enrolled in services and that a provider could not provide both case management services and other HCBS services to the same enrolled person.    Under this interpretation, a provider could provide both case management and other HCSB services, just not to the same individual at the same time.  These are two vastly different interpretations of the conflict of interest statutes.  We request that these interpretations be clarified in writing to all potential interested parties.  Additionally, we would expect that the same standards be applied to ALL providers of BI TCM, so that existing providers of other HCBS would be ineligible to provide TCM if the initial interpretation of the conflict of interest is valid.  

CommentID: 217105