BMS Provider Manual, Chapter 501 Aged and Disabled Waiver (ADW) — Provider Agency Certification and Conflict-Free Case Management (Sections 501.3–501.3.1)

What this rule requires your agency to do

• 1Conflicts of interest are prohibited; the case manager cannot be related by blood or marriage to the member for whom they write the Service Plan, and violations may result in loss of ADW certification for one year (§501.3).(BMS Provider Manual, Chapter 501 Aged and Disabled Waiver (ADW) — Provider Agency Certification and Conflict-Free Case Management (Sections 501.3–501.3.1))
• 2The provider must accept referrals in the UMC's web portal within five business days or forfeit the referral (§501.3).(BMS Provider Manual, Chapter 501 Aged and Disabled Waiver (ADW) — Provider Agency Certification and Conflict-Free Case Management (Sections 501.3–501.3.1))
• 3Where a conflict-free exception is granted, any case manager in an agency also providing personal attendant services must sign a Conflict of Interest Assurance form, which must be placed in the member file; absence of the form at review results in sanctions (§501.3, Safeguards).(BMS Provider Manual, Chapter 501 Aged and Disabled Waiver (ADW) — Provider Agency Certification and Conflict-Free Case Management (Sections 501.3–501.3.1))
• 4Agencies must have written policies ensuring court-appointed guardians are informed of reported incidents as soon as possible and in all cases within 72 hours of the agency learning of an incident (§501.3).(BMS Provider Manual, Chapter 501 Aged and Disabled Waiver (ADW) — Provider Agency Certification and Conflict-Free Case Management (Sections 501.3–501.3.1))
• 5Agencies must meet and maintain the certification requirements list, including a WV business license, FEIN, competency-based training curriculum, Quality Management Plan, and written complaint/grievance, electronic device, transfer, and discontinuation policies (§501.3).(BMS Provider Manual, Chapter 501 Aged and Disabled Waiver (ADW) — Provider Agency Certification and Conflict-Free Case Management (Sections 501.3–501.3.1))
• 6ADW provider agencies must be certified by the OA and must submit a completed certification application to the OA (§501.3).(BMS Provider Manual, Chapter 501 Aged and Disabled Waiver (ADW) — Provider Agency Certification and Conflict-Free Case Management (Sections 501.3–501.3.1))
• 7An agency providing both case management and personal attendant services must maintain a separate certification and NPI for each service, separate staffing, and separate files, and may not provide both services to the same member unless BMS grants a waiver with safeguards (§501.3).(BMS Provider Manual, Chapter 501 Aged and Disabled Waiver (ADW) — Provider Agency Certification and Conflict-Free Case Management (Sections 501.3–501.3.1))
• 8Provider agencies will be reviewed by the OA within six months of initially providing services and annually thereafter, and Crime Identification Bureau (CIB) background checks recur every five years (§§501.3, 501.3.1).(BMS Provider Manual, Chapter 501 Aged and Disabled Waiver (ADW) — Provider Agency Certification and Conflict-Free Case Management (Sections 501.3–501.3.1))