Case Management Redesign Frequently Asked Questions (FAQs)
The Department of Health Care Policy & Financing (Department) has posted a series of FAQs to the Case Management Redesign webpage to offer answers to common questions about the initiative. In the coming months, the Department will share these FAQs through this newsletter to inform case managers of the coming changes.
Q: What if we don’t implement CMRD?
A: If Colorado does not come into compliance with conflict-free case management, the risk is losing federal funding, which is 50% of home and community-based services. This would be detrimental to people in Colorado being able to access these vital services in the future.
Q: What does “conflict-free” mean?
A: “Conflict-free” means a case management agency will not provide both case management services and direct services to an individual, because this creates a conflict of interest.
The Centers for Medicare & Medicaid Services (CMS) defines conflict-free case management as: “Providers of home and community-based services (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 service plan, except 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 HCBS. In these cases, the State must devise conflict of interest protections including separation of entity and provider functions within provider entities, which must be approved by CMS.”