Department for Aging and Disability Services
Home MenuConflict-Free Case Management Policy
Right now, in Kansas, the same organization can provide both case management and direct services for people with disabilities. This practice creates conflicts of interest (COIs) that can influence decisions about service plans, limit genuine choice, and undermine individuals' trust. Separating case management from direct services will remove these COIs and protect the future of Home and Community-Based Services (HCBS) in Kansas.
Full Conflict-Free Policy
The policy on conflict-free case management explains:
- When service providers can and cannot deliver conflicting services
- The safeguards that protect participants
- The rights participants have when receiving conflicting services
Why This Policy Is Necessary
Conflicts of interest can cause problems for both individuals receiving services and for Kansas's Medicaid system as a whole. All the problems below can occur when one organization decides which services an individual will receive and then provides them.
How COIs Can Impact People Receiving Services
- An individual's person-centered support plan may over- or under-authorize services.
- Case managers may drop individuals who "cost too much" or "do not bring enough revenue."
- Case managers may feel pressure to steer individuals to their own (parent) organization for services instead of to the best choice.
- Case managers may try to keep an individual as a client instead of following their requested/needed service changes.
- Case managers may not feel able to advocate as much for individuals due to pressure from the provider.
How COIs Can Impact Kansas's Medicaid System
- Kansas could lose approximately 60% of its Medicaid funding for not following federal rules
- The Centers for Medicare and Medicaid Services (CMS) can withhold the approval of future waivers—such as the new Community Support Waiver (CSW).
- Providers may be ineligible for continued enrollment as providers.
Separating service provision from case management is the best way to follow person-centered principles and protect the integrity and funding of HCBS in Kansas.
CMS Letter to Kansas About COIs in Our HCBS System
On December 16, 2024, the Deputy Director of CMS, Anne Marie Costello, sent a letter to the Kansas Department of Health and the Environment (KDHE). The letter outlined CMS's position that Kansas is not compliant with the conflict-of-interest provision of federal HCBS regulations.
Overview of the Conflict-Free Policy
The Centers for Medicare & Medicaid Services (CMS) generally does not allow a single organization to provide both direct services and case management to the same participant.
There are three ways for a provider to follow CMS rules on conflicts of interest:
- They only offer case management or direct waiver services, never both.
- They offer case management and direct waiver services, but never to the same person.
- They offer both case management and direct services to the same person, and KDADS has given them Only Willing and Qualified Providers (OWQP) Approval.
The goal of this requirement is to address conflicts of interest. Conflicts of interest occur when what is best for a company and what is best for a participant may not align.
KDADS will only approve providers as OWQPs for a service (option 3 above) if every other provider in the county is unwilling or unqualified to provide either TCM or the direct service. Providers with OWQP approvals for a service must also implement protections to reduce the impact of conflicts of interest on participants.
Rules for OWQPs
When KDADS issues a provider an OWQP Approval, the provider must follow certain rules to maintain it and help protect participants. You can see the list of rules below.
KDADS can penalize any providers that break these rules, including requiring them to stop offering targeted case management and/or to submit a corrective action plan. An OWQP Approval is valid for only one year. After that, a provider must apply to renew it.
Keeping Case Management and Direct Services Separate
OWQP Providers must take certain steps (called "administrative separations”) to keep their case management work separate from their direct service work. These separations include:
- Hiring different people for case management and direct services
- Using different managers to supervise case management and direct service staff
- Making sure case management and direct service staff work in different physical areas
- Storing physical files for case management and direct services in different areas
- Installing firewalls to keep electronic files, data, or information separate
Explaining Conflicted Services to Participants
Before a provider can deliver conflicted services, the CDDO must explain them to participants and obtain their consent. All participants must sign a consent form and give their informed consent. The policy details how the CDDO will share this information with MCOs and KDADS.
Moving Participants to Nonconflicted Providers
If a new, nonconflicted provider becomes available, CDDOs must:
- Let participants getting services from an OWQP know that a nonconflicted provider is available
- Help the participant transition to a nonconflicted provider (if the provider is available during the participant's annual plan renewal)
When a participant complains about their OWQP, their case manager must share that complaint with the participant's MCO and CDDO. Afterward, the MCO must ensure that the participant's concerns are appropriately resolved.
Participants can also file a dispute with KDADS if they think KDADS was wrong to give a provider an OWQP Approval.
Monitoring and Oversight
KDADS and CDDOs will work together to ensure that providers follow the policy's rules.
KDADS will review claims data to ensure that every organization providing conflicted services has an OWQP Approval. KDADS will also check that OWQP providers have the right separations in place.
MCO Care Coordinators and Case Management
If a conflicted provider does not follow the policy, they will lose their OWQP Approval. In that case, the participant's MCO Care Coordinator will temporarily take over case management.
Applying for OWQP Approval
CDDOs apply for OWQP Approvals on behalf of providers. Applications can be submitted for an agency to serve as the OWQP for a specific participant or for an entire county for specific service(s).
Before submitting an application, CDDOs will check whether there are any other willing and qualified providers in the area and whether the provider has the right separations in place.
They will also collect consent forms before an organization starts providing conflicted services.
KDADS will review complete applications within 10 business days and notify CDDOs and MCOs of its decision.