New Hampshire’s service delivery system for individuals with intellectual disabilities and acquired brain disorders is facing significant change as a result of federal rules that govern conflicts of interest and that allow for service providers to receive Medicaid reimbursement directly without having it “pass through” an Area Agency. The Centers for Medicare and Medicaid Services (CMS) has determined that New Hampshire’s service system does not comply with these rules, and as a result, New Hampshire is operating its Developmental Disability and Acquired Brain Disorders Medicaid Waivers under a Corrective Action Plan.
The applicable CMS rule prohibits agencies from providing direct services and case management to the same individuals. 42 CFR 431.301(c)(1)(vi). But the rule does include an exception when the State demonstrates that the only willing and qualified entity to provide case management and/or develop person-centered service plans in a geographic area also provides direct services. In the case of that exception, the rule indicates that the State must devise conflict of interest protections including separation of case management and provider functions within the entities, which must be approved by CMS. All that said, because the rule’s requirements re: agency conflict are tied to individuals, it allows an agency to provide both direct services and case management, as long the agency is not providing both to the same individual/s.
The Bureau of Developmental Services (BDS) has formed a stakeholder advisory group to give recommendations to BDS as the state works through the corrective action plan and comes in compliance with federal regulations. Members of this group represent the Area Agency System, Family Support Council, Quality Council, Private Provider Network, Brain Injury Association, the NH Council for Developmental Disabilities, and other partner organizations.
To stay up to date on all the changes that are happening you can visit the Bureau of Developmental Services Corrective Action Plan link below.