An Interview with Catherine Strode
The bill implementing conflict-free case management for individuals with intellectual and developmental disabilities who are eligible for home and community-based services under the medicaid program is on its way to the Governor to be signed into law. House Bill 17-1343 was sponsored by State Representative Dave Young, a member of the Joint Budget Committee. It passed both the Senate and the House on unanimous votes of 35-0 and 65-0, respectively.
In an interview with Catherine Strode, State Representative Young discusses the primary motivation for the Joint Budget Committee bill. He says the driver was not actually federal rule compliance but a long persisting human rights issue.
What problem does this bill address?
“It addresses the conflict of interest problem that has persisted for many years here in Colorado. The core of the conflict of interest is, essentially, one I classify as a human rights issue. There should be choice in the system. The core of that choice is people need to have the option of who they have as a case manager; and the case manager should not be employed by the same entity that provides services. When the same entity provides both case management and services to the individual, there is an inherent conflict of interest. As an example, let’s say the person needs services A, B, and C. There’s a possibility the case manager may say, “You’re going to be given services X, Y, and Z” because those are the only services provided by that entity. Even though you may not need X, Y, and Z, those are the ones your case manager puts you into for services. If the determination is made that you need A, B, and C, the case manager should be seeking out those services. If they are independent from the entity that provides services, they will pursue the options that are available because there won’t be a conflict of interest. The goal of the bill is to make sure people get the services they need when they need them.”
How did you become interested in this issue?
“My sister was involved in a conflict of interest situation. She went through 20 residential placements in one year. It was chaos. We were in a conflict of interest situation. We kept being presented with the same kind of residential placement, a host home. We were being told that was our only option. In fact, my sister’s needs are much more intense. There were very few host home providers that were capable of providing the type of service and care she needed to be successful residentially. Many of the host home providers were not trained with the skills needed to deal with my sister’s situation and not provided with the level of support they needed. There were a couple of instances when the host home provider became so exasperated with her, the provider asked her to leave in the middle of the night. If there had been a more appropriate option presented to us we would have taken it. I know now there are many other options available. We were not presented with them.”
Is compliance with federal rule the primary motivation for the bill?
“One of the reasons I ran this as a Joint Budget Committee bill is that there are implications for sanctions with the state. We got a letter from the Centers for Medicare and Medicaid Services (CMS) November 1, indicating we were out of compliance with the final settings rule. However, that’s not the primary driver. This issue has existed for many years. We need to ensure that people have the option to get the appropriate services they need. When they are given services that are appropriate, that’s a human rights issue. To me the primary driver is human rights.”
What compromises were made with stakeholders?
“There are some significant concerns about what conflict free case management means. How do we define it in statute in a way that is actionable? What we ultimately came up with was something similar to what the federal guidelines say: whatever agency provides case management to a person cannot also provide services to that person. That means an agency could actually provide both case management and provide services. We just want to make sure they are not providing both to the same person. There were issues around how the rural districts and the frontier districts are going to be able to meet these demands. The Community Centered Board (CCB) may be the only one available in that area who can provide both services and case management to someone. We tried to provide those CCBs enough time so they can work through a process with CMS. There were some that felt the timeline is too long (five years). For those in some of these rural and frontier areas, it may take them that long to really make it work. We have a full array of how different areas are approaching this and some of the compromise may be to accommodate those that may find it more difficult to get that done.”
The bill authorizes use of the IDD cash fund. Is this consistent with the intent of the cash fund?
“I believe it is. This is the recommendation of our Joint Budget Committee Analyst. She originally worked with JBC to set up the cash fund guidelines. The real intent is that this money reverts back into the state coffers because it is unspent. The purpose is to catch the money and make sure the money gets spent to the benefit of those with IDD. I believe solving this conflict of interest is certainly a very appropriate use of that money.”
Catherine Strode is Advocacy Denver’s Policy Outreach Specialist. Formerly the Coordinator of the Health Care Advocacy Program, she holds a Masters degree in Public Administration with an emphasis in Health Care Policy. Catherine publishes Policy Perspective, featuring interviews with state policy makers on issues that affect the work and mission of Advocacy Denver.