Project Specific Updates & Technical Assistance for Providers - February 19, 2021
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Project Specific Updates &
Technical Assistance for Providers
Office of Community Living
Colorado Department of
Health Care Policy & Financing
February 19, 2021
Overview
1. Introductions
2. Electronic Visit Verification
• Colin Laughlin, Office of Community Living Deputy Director
• Lana Eggers, Waiver Administration & Compliance Unit Supervisor
3. Case Management Redesign: Assessment and Person-Centered
Support Plan
• Amanda Lofgren, Office of Community Living Case Management and Quality
Performance Division Director
• Michelle Topkoff, Entry Point & Case Management Manager
4. Questions
2
Monthly Webinar Structure
• Disability, Older Adult, and Advocacy Community
Focused on member needs (ex. changes to programs or services)
More high level, less technical in nature
• Provider Webinar
Focused on provider needs (ex. questions about billing)
More technical
As needed additional webinar each month diving deep
on a topic
www.colorado.gov/hcpf/office-community-living-update-webinars
3
Electronic Visit
Verification
4
Electronic Visit Verification
• Electronic Visit Verification (EVV) is a technology solution used to verify that
home or community-based services are delivered.
• Section 12006 of the 21st Century Cures Act requires EVV for select Medicaid
services.
• Providers may utilize the State EVV Solution or a Provider Choice EVV System.
• A list of services which require EVV can be found in the EVV Program Manual.
• EVV implementation may cause provider fluctuation. Case managers may need
to assist members in finding a new service provider.
5
What must EVV Capture?
TYPE OF INDIVIDUAL DATE OF THE
SERVICE RECEIVING SERVICE
PERFORMED THE SERVICE
LOCATION OF INDIVIDUAL TIME THE
SERVICE PROVIDING SERVICE BEGINS
DELIVERY THE SERVICE AND ENDS
6
Implementation Timeline
• EVV was mandated in Colorado by 10 CCR 2505-10 8.001 on August 3, 2020. EVV will be enforced through a
both post-payment claim review and a pre-payment claim edit.
• Claims that require an EVV record are shown in a providers Remittance Advice as EOB Code 3054 “EVV
Record Required and Not Found.”
• Pre-payment claim review was delayed from January 1, 2021 to March 1, 2021, for providers who are
utilizing or making good-faith effort to utilize EVV.
• Providers who are not making a good-faith effort to use EVV were subject to claim suspension beginning
January 16, 2021.
• The Department intends to delay the pre-payment review claims edit again beyond March 1st.
• Continued non-compliance and evidence of inappropriate billing activities of any kind may result in a full
review and recoupment of funds.
7Avoiding Billing Errors
8Avoiding Billing Errors
9Avoiding Billing Errors
10Additional Information
Pathway Method Purpose
1-855-871-8780 Using State EVV Solution, interfacing
EVV Help Desk Provider Choice Systems, Sandata
COCustomerCare@sandata.com trainings, EVV accounts.
Gainwell (Billing) Help Desk Provider billing or claims processing
1-844-235-2387
questions.
Dept. approval of Live-in Caregiver
exemption, policy or program
HCPF EVV Inbox EVV@state.co.us
questions, escalations from other
support methods.
EVV Website colorado.gov/hcpf/evv Additional information and resources.
11EVV
Questions?
12Case Management
Redesign
13Case Management Redesign
• Case Management Redesign refers to several initiatives that will help make
accessing services and supports easier, by:
Changing case management agencies to serve all HCBS waivers so people have one
place to go
Making sure there are the right number of case management agencies in Colorado and
increasing the quality of case management services
• Contract executed with HCBS Strategies
Contract work includes:
Implementation Goal:
Catchment area development July 1, 2024
Only willing and Qualified Provider
OHCDS and initial Quality Framework
14Case Management Redesign
Also included in Case Management Redesign are:
A new eligibility and needs assessment process
A new person-centered support planning process
A new way to assign budgets (called a Person-Centered Budget
Algorithm)
The assessment and support planning processes will be used
starting this summer and we will be providing more information
over the next few months
1516
Benefits for…
Individuals / Members Case Managers
• Allows for a more person- • Automated system guides
centered process questions from responses
• Deciding who information is • Level of Care more clearly
shared with identified
• Ability to share personal story • Reduction of duplication of
with providers work
17FINAL Assessment and Support Planning Process
18PCBA Timeline Update
Summer 2021 Summer 2022 –
Jan.-May 2021
Summer 2023
• Work with the • Go live with • Pilot PCBA with
Care & Case new Assessment all members
Management and Person- seeking or
(CCM) System Centered • With sufficient receiving HCBS
vendor for • Begin Support Plan data from new • Evaluate and
• Requested
workaround stakeholder and CCM assessments, adjust PCBA as
additional time to
and plan for work on system pick back up needed • Implement
complete PCBA
systems structure for work with PCBA for all
(rollforward
transition PCBA exceptions stakeholders members
request)
process, start and Optumas to seeking or
• Pause PCBA with working continue PCBA receiving
development with TAG development HCBS
Fall 2021 -
January 2021 Spring 2021 Summer 2023
Spring 2022
* Timeline dependent on rollforward request approval by Colorado General Assembly
19Care & Case Management
(IT) System
Consolidates case management functions that currently exist across
several systems into a single system called CCM:
• New Assessment and Person-Centered Support Plan
• Service authorization
• Other functions of case management, such as:
Log Note Entry
Critical Incident Reporting
Reports
• Allows for automated outputs to aid in support planning
• Interfaces with the Bridge, CBMS and PeakPro
20Eligibility Determination
Changes
• Creates one CBMS Program Aid code that signals HCBS
level of care met
• Improves approval process for members
• Improved efficiency for members
• Retaining existing Program Aid codes for PACE, ICF/IID,
and NF
21PEAKPro Improvements
• Facilitates bi-directional data transfer
between CBMS and CCM System
• Electronic LOC referral processing among Case
Management Agencies and county techs
• PEAKPro updates pushed at same time CCM System
integrated
22Stay Engaged
• Care and Case Management page
• New Assessment and Person-Centered Support Planning page
• Person-Centered Budget Algorithm page
• CCM Frequently Asked Questions
• Office of Community Living Stakeholder page
• Sign up for Constant Contact announcements
23CMRD
Questions?
24Other Updates &
Reminders
25New Stakeholder
Engagement Public
Calendar
The calendar is located on the Office of Community
Living (OCL) Stakeholder Engagement webpage. It
contains public meetings managed or co-managed
by OCL. New meetings and revisions to existing
meetings will be added as needed.
Members of the public can now use the calendar to:
• Browse for a particular meeting, by using the "Week",
"Month", or "Agenda" options
• Browse for meetings of particular interest to them
26New Stakeholder Engagement Public Calendar
Stakeholders can add the whole calendar to their
preferred calendaring system (Google, Outlook, etc.)
or copy individual events as needed
Announcement about meetings (new meetings,
changes to existing meetings, cancelations) will be
sent out through the Long-Term Services & Supports
Stakeholders Newsletter (subscribe here)
OCL staff will be using this calendar to ensure
minimal conflict between meetings on the calendar
intended for the same audience.
One of the top goals for the calendar is to stop
"double-booking" our stakeholders!Stay Engaged
Memos, Webinar Info, and FAQs - Updated Regularly
www.colorado.gov/hcpf/office-community-living-update-webinars
www.colorado.gov/hcpf/long-term-services-and-supports-covid-19-response
Email us
HCPF_HCBS_Questions@state.co.us
Subscribe to Future Updates
Click here to subscribe
282021 Guidance
Case Management Agencies HCBS Providers
CDASS FMS Transition EVV Timeline Update
Notification
• OM 21-007
• OM 21-010
Updated CM Opp
Changes in Response to Changes to Benefits and
COVID-19 Services Rates in Response
• OM 21-013 to COVID-19
• OM 21-009
Facilities and PACE Operational changed to
PACE Participant Temporary Rate NEMT for COVID-19
Adverse and Increase for NF, • OM 21-012
Expedited Appeals ICF, RC
• OM 21-006 • OM 21-008
All 2021 Guidance can be found here: www.colorado.gov/hcpf/2021-memo-series-communication 292020 Guidance
Case Management Agencies HCBS Providers
Operational Changes Critical Incident Reporting HCBS Therapy Services
• OM 20-049 for COVID-19 • OM 20-020 Additional Provider Relief Funds
• OM 20-027 • OM 20-080 Guidance for Class B Providers • IM 20-024
• OM 20-037 Level of Care Changes • OM 20-023 Non-Medical Transportation
• OM 20-045 • OM 20-053 Changes to Benefits & Services • OM 20-063
Transition Coordination (Table) Retainer Payments Ending
• OM 20-075
• OM 20-056 • OM 20-046 • OM 20-069
PASRR Changes
In-Person & Travel Add-On Telemedicine Guidance for Reopening or Expanding Day
• OM 20-043
• OM 20-076 • Temporary Policy Programs
Host Home Inspections • OM 20-070
• OM 20-036 CDPHE TA for IRSS
Facilities and PACE CDASS Sick Time • IM 20-031
• OM 20-047 Updated Residential Guidance
Infection Control And Rate Increase
Changes to Benefits & Services Rates • OM 20-072
Prevention in NHs (CMS) • OM 20-050 (Table) Telehealth Billing Requirements
• CMS QSO-20-14-NH Options Counseling • OM 20-048 • OM 20-077
Telemedicine in Nursing • OM 20-054 Flexibility in Hiring Day Hab Svcs in Response to COVID-19
Facilities Stimulus Payments • IM 20-019 • OM 20-083
• OM 20-032 • OM 20-059 CC & SCC Clarifications
Training & Certification Civil Money Penalty (CMP)
• OM 20-038 • OM 20-060
• IM 20-021
All 2020 Guidance is Archived here: www.colorado.gov/hcpf/2020-memo-series-communications 30Next Webinars
Friday, March 5, 2021
10:00 – 11:00 AM 1:00 – 2:00 PM
Disability, Older Adult, & Provider Update &
Advocacy Communities Technical Assistance
Webinar Call-in Information: Webinar Call-in Information:
Phone: 720-279-0026 / Toll Free: 1-877-820-7831 Phone: 720-279-0026 / Toll Free: 1-877-820-7831
Participant code: 174363# Participant code: 174363#
Webinar Link Webinar Link
31Thank you!
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