1. 24-hour emergency services: Please clarify what that entails for the individual organization that provides TCM.
2. Ability to serve: ‘Demonstrate the ability to serve individuals in need of comprehensive services regardless of an individual’s ability to pay or eligibility for Medicaid reimbursement. (i.e., lapse in coverage, transitional care, etc.)’
For clarification, we believe it should read ‘Demonstrate the ability to serve individuals in need of non-medial comprehensive brain injury services regardless of an individual’s ability to pay or eligibility for Medicaid reimbursement. (i.e., lapse in coverage, transitional care, etc.).
Question: How will the organization get reimbursed if a client is not able to pay or eligible for Medicaid reimbursement? This could be costly.
3. Conflict of Interest: Please clarify this: ‘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.’
While throughout the development of TCM services this COI was emphasized, in the most recent meeting with DMAS is was said at three different occasions that an agency could provide both, TCM and other direct brain injury services but the agency could not provide TCM and other services to the same person.
a. This is contradicting information and has great consequences for the current brain injury providers. This needs written clarification.
b. Does either one apply to all providers (including CSBs)? It should, otherwise it will create an unfair (financial) situation between CSBs and all other service providers which will be certainly interesting to all stakeholders.