Conflict-Free Kansas
Right now in Kansas, the same organization can provide both case management and direct services for people with disabilities. This 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.
“A key component of federal HCBS regulations is the conflict-of-interest provision, with which Kansas is not compliant”
— Letter from the Centers for Medicare & Medicaid Services (CMS) to the Kansas Department of Health and Environment (KDHE) on 12/16/2024
“Only separating the gatekeeping and service providing functions would fully eliminate potential conflicts of interest”
— 2014 Report by the Legislative Division of Post Audit
Eliminating Conflicts of Interest in HCBS is Essential…
Community Developmental Disability Organizations (CDDOs), Targeted Case Managers, Community Service Providers (CSPs), and everyone else in HCBS all work incredibly hard to provide the best services to Kansans with I/DD. Still, there are many reasons Kansas must eliminate conflicts of interest in HCBS.
About 60% of Kansas’s Medicaid funding comes from the federal government. If Kansas does not address these conflicts of interest, the state could lose that federal funding. Without federal funds, Kansas would have to cut services or serve fewer people.
To Protect Medicaid Funding
There are a lot of people in Kansas on the waitlist for services through the Intellectual and Developmental Disability (I/DD) Waiver. That's one reason the Kansas Legislature directed KDADS to create the new Community Support Waiver (CSW): to provide services for Kansans with I/DD who do not need 24-hour support. But the CSW needs approval from the Centers for Medicare and Medicaid Services (CMS) and CMS won’t approve any new waivers until Kansas addresses COIs.
To Create the New Community Support Waiver
Most likely, no providers or case managers are using these conflicts of interest to act unethically. But even if they aren’t, the fact that these conflicts exist is enough to create doubts in the minds of individuals receiving services. If COIs are eliminated completely, then individuals can be absolutely sure that providers have their best interests in mind.
To Ensure Individuals’ Trust in the HCBS System
The Settings Final Rule from CMS went into effect on March 17, 2014. Among other things, the rule states that HCBS providers cannot also provide case management. All providers need to follow the Final Rule. So, any providers that still have COIs would no longer be eligible to enroll as providers.
To Keep Providers Eligible
Learn More about COIs including
What CMS Has to Say about Kansas
What Are Conflicts of Interest?
No sure what counts as a conflict of interest or how Kansas’s HCBS system creates them? Check out this page to find out more about both.
Federal Rules around COIs in HCBS
The Final Settings Rule covers conflicts of interest in HCBS. Explore this page to learn about the rule and find out what the Centers for Medicare & Medicaid have to say about Kansas’s system.
Grant Funds to Help Eliminate COIs
KDADS has created the Conflict-Free Kansas Grant to help providers comply with other federal regulations, and address conflicts of interest.
Partnering with Public Consulting Group on Conflict-Free Kansas
In April 2024, KDADS contracted with Public Consulting Group (PCG) to help create a roadmap and grant program to address conflicts of interest in the HCBS system.
PCG is a leading public sector consulting firm that works with health, education, and human services agencies to improve lives. Created in 1986, PCG has more than 1,900 employees in more than 35 offices in the United States, Canada, and Europe. PCG works almost exclusively in the public sector and understands the laws, regulations, and budget concerns that determine how a state agency can serve citizens.
For over 30 years, PCG has helped states manage Medicaid programs. PCG has worked with multiple states as they developed new Medicaid waivers and waiver services.