Committee postpones case-management rule after providers press telehealth, payment and oversight questions

A joint legislative committee on administrative rules postponed Department of Health and Human Services rule 25-3-04, which would revise case-management requirements for the Community First Initiative (CFI). Lawmakers said they needed clearer language about telehealth oversight, the agency’s 10-working-day deadline for accepting or denying assignments, and when case management agencies begin receiving state payments.

Caroline Virchick, who was introduced to the record as representing Granite Case Management Services, told the committee she has operated case-management and home-health firms for more than two decades and that the rule "requires us to admit them, which, is not right." Virchick said the provision could force agencies to accept referrals for people they have not verified, and complained that the rule would shift oversight of other providers’ telehealth practice onto case managers.

Agency attorneys and administrators responded that case management remains core to CFI and that the rule is intended to make sure telehealth delivery matches each participant’s person-centered care plan. Brian Clark, general counsel for the Bureau of Adult and Aging Services, said the department is asking case managers to confirm whether "this person want[s] services delivered by telehealth" and whether the participant has a device or would be isolated by telehealth — not to supplant a medical provider’s clinical judgment.

Members pressed the agency on the proposal’s 10-working-day accept-or-deny window, and on when payments begin if an agency accepts an assignment but cannot locate the participant. The department said that an accepted assignment can create an open service authorization that allows payment ("one day of the month with this open service authorization and open eligibility, they can be paid for the entire month"), that the department runs vital-records and Social Security cross-matches when a death is later suspected, and that oversight includes a monthly contact requirement and annual quality reviews.

Because substantial questions remained — including whether the rule text properly mirrors existing statutes and whether the 10-day timeline, conflict-of-interest definition, and monthly-payment practices create fraud risk or unreasonable burdens — Representative (speaker 3) moved to waive the timetable and postpone consideration until the committee’s next meeting. The motion was seconded and approved by voice vote. The committee directed agency staff to supply additional cited rule references and clarifying materials before the next hearing.

The postponement leaves unresolved whether the department will revise the language to require case managers to document contact before payment, change the assignment/conflict-of-interest definition, or alter telehealth-related language so case managers do not exercise regulatory control over other licensed providers. The committee said it expects the agency and staff to return next month with clearer cross-references and drafting edits.

The next committee meeting will revisit 25-3-04; no vote on adopting the rule was taken today.