Conflict Free Case Management
On January 7, 2015 the board of directors for Community Support Network Inc. (CSNI) voted to adopt a “Protocol to Remove Conflict” in the provision of case management services for its member agencies. This protocol reflects current practice in the system.
Conflict Free Case Management is one of the three structural change requirements that apply to all states that have accepted grant funds from the Center for Medicaid Services (CMS) through the Balancing Incentive Program (BIP). CMS provides guidance for states on how to insure that case management is conflict free.
Protocol for Removing Conflict
New Hampshire’s developmental services system revised its regulations more than a decade ago to provide its consumers with choice and control over all aspects of their services, including selection of providers. Within that approach, consumers are able to choose their service case managers. Notwithstanding that opportunity, the great majority of the individuals currently receive their case management services from area agencies, geographically dispersed throughout the State, some of which also provide direct services.
Although NH regulations clearly articulate case management responsibilities, the current organizational arrangement of case management services can give the impression it is not “conflict-free” in all cases. Developing and adopting stronger conflict of interest standards for the State’s Developmental Services System could provide greater assurances to individuals and their families regarding the disposition, transparency, and integrity of the advocacy that their case managers would provide. For this reason the Protocol to Remove Conflict will insure that the following mitigating factors will be in place to remove conflict:
Assuring that individuals can advocate for themselves or have an advocate present in planning meetings.
- People served by the area agency have annual service planning meetings and can direct who they would like to attend and serve as advocates. Administrative rules require that the person be given an opportunity to confirm in writing if they wish to continue being assisted by their current case manager or if they wish to choose an alternative.
Documentation that the individual has been offered choice among all qualified providers of direct services.
- In establishing initial service supports the option of being served by a qualified external provider agency is presented to the person and other team members*, based on the availability of such providers within the agency’s catchment area. Those options are based upon a match of service capacity by the provider agency and a positive indication from them that they are able and willing to develop appropriate new services, within the available resources to the individual. The decision by the individual and/or their guardian or representative to pursue an external provider agency is documented in the Service Agreement.Any decision to consider an external provider agency is followed by a guided interview and selection process. The person served and their guardian and/or representative, if applicable, participates in the selection process for proposals that sufficiently meet minimum requirements and are within resource allocations. On an annual basis the person confirms in writing the continued provision of service by their providers. Administrative rules dictate that providers of direct service are to be chosen by the person and can be terminated.(Note: *The team may be multidisciplinary and may include, but not be limited to the following participants: The individual or guardian as appropriate; the service coordinator; persons directly involved in conducting evaluations or assessments; providers, as appropriate; and, as requested by the individual/guardian, family members; an advocate, or persons outside the family.)
Establishing administrative separation between those doing assessments and service planning and those delivering direct services.
- Area agencies have separate program directors for the divisions within the organization that do assessment and services planning and those that deliver direct services.
Establishing clear, well-known, and easily accessible means for consumers to make complaints and/or appeals to the State for assistance regarding concerns about choice, quality, and outcomes.
- BDS has established clear processes by which individuals can grieve decisions they consider adverse or submit complaints and appeals regarding individual service eligibility. These processes are available in writing at each area agency and on the BDS web site. Complaints can be made via phone or written communication. The complaint process is managed independently by BDS and reviewed by the Developmental Services Quality Council. Those who are 21 or older will also have their abuse or neglect grievance investigated simultaneously and independently through a process conducted by the Bureau of Elderly & Adult Services. Eligibility notifications involving denials include information on how to file an appeal and how to receive assistance through the Disabilities Rights Center.
Having state quality management staff to oversee providers to assure consumer choice and control is not compromised.
- Personnel employed by the not-for-profit Community Support Network Inc. (CSNI) conduct annual interviews with a randomized selection of service recipients using the National Core Indicator questionnaire that includes review of choice and control. Findings are summarized a reported to a Quality Council for Developmental Services whose membership reflects broad stakeholder representation as established by the New Hampshire legislature.
Clinical/non-financial eligibility processes are conducted by personnel employed by the CSNI organization with recommendations to the area agency directors. Financial eligibility is determined by the Bureau of Developmental Services.
The NH Department of Health and Human Services has established Ombudsman program that serves as an independent and confidential resource to individuals and their families as appropriate.
- The DHHS Ombudsman Program is charged with assuring that the concern and/or complaint investigation and resolution process will be managed to protect from harm or any form of retaliation. DHHS Ombudsman supports individuals with disabilities and their families as they make informed choices.
Area Procedure for Protocol to Reduce Conflict
To download a copy of sample procedures designed for consideration by agencies in adopting practices that fall within the “Protocol to Reduce Conflict” for CSNI affiliated agencies, please use the link below.
Nine Elements for Conflict Free Case Management System
To download a copy of the Nine Elements for Conflict Free Case Management System, please use the link below.
Certificate of Agency Compliance
Area agencies across New Hampshire have implemented administrative practices that are in conformity with protocols to remove conflict regarding the provision of case management services. To see declarations of participating agencies, please use the link below.