By Morgan Chilson, Kansas Reflector
TOPEKA — Complying with a federal policy designed to avoid conflicts of interest could cause “massive system disruption” for Kansans who have intellectual and developmental disabilities, an advocate told legislators last week.
Multiple people testified Sept. 25 before the Special Committee on Health and Social Services, to raise concerns about proposed changes because of a rule from the Centers for Medicare and Medicaid Services.
Kansas is out of compliance with the rule and stands to lose $350 to $400 million in federal funding if changes aren’t made, said committee chairman Rep. Will Carpenter, R-El Dorado.
The Kansas Department for Aging and Disabilities Services is addressing the issue as part of an overall strategy to modernize its home and community-based support waiver program.
To avoid conflict of interest, individuals with IDD who are on Medicaid cannot receive services from the same organization that provides their case management, said Jeanine Zlockie, National Association of State Directors of Developmental Disabilities Services.
A case manager who has a financial relationship with the service provider could, for instance, feel pressured to steer a client to their company’s services, rather than objectively determining best services, she said.
CMS rules allow for workarounds in certain situations, such as in rural areas where there are limited providers, Zlockie said.
“The direction we’ve set based on these consensus recommendations is that there will be no dual service provision under a conflict-free system in Kansas,” said Seth Kilber, a KDADS assistant commissioner. “It’s going to require us to map the current state and the future state, defining those swim lanes for what each entity is able to actually do and perform.”
Paul Coffell, targeted case management supervisor for Starkey Inc. in Wichita, said the Kansas system already has conflict of interest practices in place and that he believes the system is strong and works well. He expressed concerns that separating organizations that provide services from organizations that provide case management would create an “invisible” waiting list as people wait for case managers.
“I would ask that everyone involved would remain open to persevering with what has been positive and successful for our TCM program instead of assuming that massive system disruption is unavoidable,” Coffell said.
Jeff Whittier, director of support services for Cottonwood Inc. in Lawrence, said the consensus reached among those working with KDADS to modernize the waiver was based on options presented to them. He called the agreement Kilber referred to as “the least damaging.”
In the Cottonwood community developmental disability organization area, Whittier said, there are 14 targeted case management providers, four of which are conflicted agencies.
“The remaining 10 are quote-unquote independent,” he said. “That sounds great on paper, since only 29% of the TCM providers in our area are conflicted.”
“In reality,” he added, “the four conflicted providers provide (targeted case management) services for approximately 66% of individuals in our catchment area.”
If the current plans addressing conflict of interest were implemented today, Whittier said, most providers, including Cottonwood, would likely divest themselves of targeted case management services.
Whittier said Cottonwood loses money providing targeted case management services, which is why most companies would choose to divest themselves of that portion of their work. He told the committee changes could be made systemwide to make the case management more sustainable, such as updating billing practices and costs.
“We really don’t have a choice in this matter, and I’m hoping that you will collaborate and be part of the solution, and everybody in this audience needs to be part of this solution,” Carpenter told Whittier. “The federal government has told us where we’re going to go with this, and I hope everyone understands that. They’ve been pretty lenient so far, but they’ve made it pretty clear we need to get our act together.”
Loved ones of people being served through the IDD program told the committee that changing case managers would negatively affect their family members.
Julie DeMarco gave examples about how the case manager who supports her 53-year-old brother, who has autism and is nearly nonverbal, has supported him because she knows him so well.
“A TCM who is not embedded, I fear, would not have that first-hand knowledge of him,” she said. “I believe the proposals break the essential links. I’m aware of the conflict of interest concerns, but I’d like to provide informed consent to keep my TCM embedded at the service provider. It should be our choice.”
