Agency Update from Max Lytle, Executive Director

Conflict-free Case Management – Where we are now

Important information for families receiving services through Developmental Connections
We hosted a meeting with many of the families we serve on June 4 of last year for the purpose of introducing the topic of Conflict Free Case Management. It was a great evening with approximately 80 of us sharing a meal of grilled hot dogs and carry-in dishes. Following the meal, we viewed a presentation on the new Home and Community Based Services requirements and the implications of Conflict Free Case Management.

At the conclusion of the presentation, I announced that the agency families had come to trust for both support services and Case Management would be reconfigured into two separate agencies to assure full compliance with the Conflict Free Case Management regulations.  I asked family members to consider serving on the new board of directors that would be created to oversee the operations of the support service programs, and several of persons graciously responded.

Over the past nine months, we have explored a number of alternative options for elimination of the Case Management conflict of interest.  We looked into the possibility of forming a cooperative with the Christian and Greene Developmental Disabilities Boards, and we looked into the concept of exchanging with them case management responsibilities for the 48 individuals for whom we are in a conflict of interest.  Either idea would help us reach compliance with the Center for Medicare and Medicaid Services (CMS) requirement, but the negative consequences of each outweighed the benefits.

After comparing the pros and cons of each new option discussed around the state, we always arrived back at the original conclusion; in order to protect Taney County’s investment in our programs and services and to assure that they and our staff remain under the supervision and oversight of a local board of directors, we need a locally controlled nonprofit corporation to become the provider of Creative Day Services and the residential supports provided to residents of Dorgan-Weaver Apartments, Combs-Redfern Apartments and the soon-to-be Saints Street Apartments.  We were so certain of this, it even became part of our strategic goals for 2016.

Or, at least that was the case until this week.  A new question has now been raised; is a county developmental disabilities board really conflict free if it is the provider of Case Management services, but still owns or controls the ownership of the residential properties in which persons who receive Case Management services reside, or does this create a fiduciary interest.

The complexity of the issue boggles the mind.  The question has been referred to attorneys experienced with the Missouri Medicaid programs and the Missouri Department of Mental Health. We will continue researching this issue to learn as much as we can, so that the eventual decision reached here in Taney County provides the most benefit possible for our consumers, their families and our staff.


If you have questions or comments, please contact me at  or 417-335-4135.