Updates for Disability, Older Adult & Advocacy Communities - January 29, 2021 (HCPF)
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Updates for Disability, Older Adult
& Advocacy Communities
Colorado Department of
Health Care Policy & Financing
(HCPF)
January 29, 2021
Overview
Executive Director Update
• Kim Bimestefer, Executive Director, HCPF
Governor’s Office and Lieutenant Governor’s Office Update
• Jarett Hughes, Senior Policy Advisor on Aging, Governor’s Office
• Josh Winkler, Disability Policy Advisor, Lieutenant Governor’s Office
Office of Community Living Update
• Bonnie Silva, Office of Community Living Director, HCPF
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
3
POLL QUESTION
4
Updates from the Executive Director
January 29, 2021
Kim Bimestefer, Executive Director
5
Battling COVID: Data to 1/28/2021
United States:
Priorities: Continue to Drive
25.6M total cases Messaging
429k deaths
1. Socially distance. Wear your
Colorado:
mask. Wash your hands.
Cases: 393,626
2. Limit gatherings. Stay
Deaths due to COVID: 4,881 disciplined.
Deaths Among Cases: 5,552 3. Get Coloradans vaccinated:
Increase volume and speed
Vaccines Dispensed
with a focus on equity and
hard to reach populations
1st Dose: 393,626
2nd Dose: 98,301
CO Contagious: 1 in 115
6
Governor Polis’s Vaccine Goals and
Progress
• 85% of Phase 1A has received one dose of the vaccine and 73% of
that group has received both dose.
• 99% SNF and 94% ALF/Group Home 1st dose by January 31, 2021
• 71% SNF and 12% ALF/Group Home 2nd dose by January 31, 2021
• The Polis administration remains focused on vaccinating 70% of
Coloradans 70 and older by the end of February 2021
• 1 in 115 Coloradans is contagious with COVID-19 - stay vigilant
7
COVID-19 Public Health Emergency
• The Federal government dictates timing and length of the PHE.
• PHE was extended on 1/8 by HHS eff 1/21/21. Extensions can be up to 90 days
each time.
• PHE allows states flexibility for emergency policies.
• HCPF has asked HHS for advance notice of future changes and time to process
"locked in" renewals.
• Updates are posted to Colorado.gov/hcpf/phe-planning
Last day of the PHE (chart Then State Plan Then Continuous Coverage Then Maintenance of Effort
assumes full 90 days Amendments (SPAs), 1135 Requirement Ends (MOE) Requirement keep
extension starting)… Waivers, and Optional Eligibility Levels & Benefits
Uninsured Testing Group the Same, Enhanced 6.2%
Ends FMAP Ends
April 20, 2021 April 21, 2021 April 30, 2021 June 30, 2021
Appendix K currently expires March 9, 2021. HCPF has requested an extension of this date to 6 months
after the expiration of the PHE.
8
Pandemic’s Impact on Health Insurance Landscape
672k Coloradans Received Unemployment Insurance March-Oct 2020
(22% of 2019 workforce); Now ~ 250k on UI.
Unemployment
Rate in Colorado:
Feb: 2.5%
Mar: 5.2%
Apr: 12.2%
May: 10.2%
Jun: 10.6%
Jul: 7.4%
Aug: 6.7%
Sep: 6.4%
Oct: 6.4%
Nov: 6.4%
(1) Colorado Department of Labor and Employment. (2) Office of State Planning and Budget, November 2020. 9
Medicaid
Category
Enrollment
Count of Clients enrolled by aid code.
Chart shows total enrollments by time periods
and the changes in its composition over time.
The two populations
which have seen the
greatest increase in
enrollment are
Medicaid Children and
Expansion Adults
10Connect for Health Colorado Update
& Biden Administration Commentary
• 179,661 Coloradans signed up during the Open Enrollment period.
o Approximately 8% above last year’s Open Enrollment.
o 69% qualified for financial help to reduce their monthly premium.
• The Biden Administration will open the federal exchanges from
February 15 - May 15, 2021
• President Biden is directing federal health officials to comb through
government rules to eliminate ones that have made it more difficult
for low-income people to join Medicaid
• Connect for Health Colorado will open our state-based exchange
from February 8 - May 15, 2021
11Health Cabinet Summit Presenters and Panelists:
Jan 12th – there were 1865 Registrants Cabinet Members: Kim Bimestefer (HCPF),
Jill Hunsaker Ryan (CDPHE), Mike Conway (DOI)
and Lt. Gov Primavera
The sessions covered:
Dr. Sami Diab, M.D., President, CO Med Society
• Kim's Keynote Kick Off on Gov/Health
Cabinet Focus Areas Michelle Mills, CEO, Colorado Rural Health Center
• State Focused Rx Panel
• Federally Focused Rx Panel Will Cook, President & CEO, Vail Health
• Employer Panel focused on hospital,
Rx costs Senators Michael Bennet and John Hickenlooper
• Rural Hospitals and Community Investment Marissa Schlaifer, VP, OptumRx (UHG)
• BH Task Force Presentation
• COVID-19 Update Presentation Dr. Gerard Anderson, Director, Johns Hopkins
Center for Hospital Finance & Management
To Listen: Dick Monfort, Owner/Chairman/CEO, CO Rockies
https://stateofreform.com/conference/2021-
hcpf-health-policy-summit/sessions/ Robert J. Smith, Exec. Dir., Colorado BGH
12Rx Report State Focus and Action Areas
• Create an Affordability Board to study,
Colorado State Prescriptions and
impact Rx costs
Expenditures by Drug Type, All Payers 2018
• Transparency in prices, profits and
Drug Type % % of
rebates prescribed expenditures
• Pass along rebates, related savings to
Generic 84% 19% ($751m)
employers & consumers
Brand Name 15% 39% ($1.5b)
• Provide prescribers access to Prescriber (non-specialty)
Tool and evidence-based guidance
Specialty Drug 1% 42% ($1.6b)
• Increasing value-based contracts and
payments
• Preparing state laws to parallel federal Link to the second edition: Reducing
laws that Prescription Drug Costs in Colorado
Report
would enable drug importation from other
countries, in addition to Canada
13Pain Relief Management
Prescriber Tool: The opioid risk metric/medication monitoring
application became operational on December 31, 2020
HCPF is onboarding prescribers so they can access the application via
EHRs. HCPF is distributing 5000 user licenses free of charge to
facilitate rapid user uptake
HCPF is partnering with Advocates to create a Pain Management
Centers of Excellence to improve pain management for those with
chronic pain. If you want to engage in the stakeholder process, which
has already started, send Jim.Leonard@state.co.us an email.
14Member Service Improvements
Following up on claim processing accuracy, provider access
increases and member call center improvements, you
should see vast improvements in the next few months on:
• Eligibility correspondence clarity
• Overall, on eligibility accuracy with new HCPF management
over CBMS
• Prior Authorizations, with new vendors 7/1/2021
15“Of all the forms of
inequality, injustice
in health is the most
shocking and
inhumane”
MLK
3/25/66
16Health Equity and Health Care Disparities
Seeking CDC Funding, State Stimulus $$, Partnerships,
Culturally Sensitive Care Delivery
“Hispanic residents are about 20% more likely
(3)
than white residents to die of treatable
conditions. There’s no one explanation for
the disparity in deaths, experts say.”
- Denver Post, Oct 4, 2020 (1)
In Colorado:
• Hispanic people are 22% of the population
and 38% of COVID cases and hospitalizations.
• Black people are almost 5% of the population,
nearly 10% of COVID hospital, 7% of deaths.
• White people are 68% of the population but
only 38% of COVID cases. (2)
(1) Wingerter, Denver Post, October 2020 (2) CDPHE data, 2020 (3) March of Dimes, Peristats, 2020 17Our Vision:
Coloradans have integrated health care and enjoy physical, mental and social well-being.
Current Mission:
Improving health care access and outcomes for the people we serve while demonstrating sound stewardship
of financial resources.
Modernizing Our Mission - New Proposed Mission:
Improving health care equity, access and outcomes for the people we serve while
saving Coloradans money on health care and driving value for Colorado.
18Health outcomes are Colorado &
Health equity is when Access person-centered and Coloradans
everyone has the positively impact a
opportunity to be as person’s quality of
healthy as possible. life.
Health access is when Improving value and
people can readily affordability for the
access timely, State and for
Equity appropriate, quality Outcomes individuals and
health care services. employers.
Our Mission:
Improving health care equity, access and outcomes for the
people we serve while saving Coloradans money on health
care and driving value for Colorado.
19Stakeholder Resource Centers
• HCPF PHE Planning Stakeholder & Partner Resource
Center available at colorado.gov/hcpf/phe-planning
• Resources and Links:
Member COVID Resources
County & Eligibility Site COVID Resources
Provider COVID Resources
20Governor’s Office Updates
Jarett Hughes - Senior Advisor on Aging
Josh Winkler - Disability Funding
Committee Coordinator and Policy Advisor
January 21, 2021
21Aging and Older Adults Update
Goal: Support the integration of recommendations from the Strategic
Action Planning Group on Aging into Colorado state government
Vision: Interagency coordination and proactive policy making that
supports healthy aging in the community
Work Efforts: Livable community development, public health and
dementia, and supporting Area Agencies on Aging
22Disability Updates
● Co-Occurring Disabilities and Behavioral Health Working Group
Goal: Provide actionable steps to improve behavioral health for people
with co-occurring disabilities and/or are aging
Meeting every-other week through April
Email youngsin.joh@state.co.us to get on the email list
● Equity, Diversity, and Inclusion
DPA is creating access standards for state agencies
CDLE is running an Employment First Advisory Partnership continuation
bill that includes a hiring incentive for people with disabilities seeking
state jobs
23Budget & Legislative Agenda
Office of Community Living
24Case 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
Strives to achieve Federal Compliance, Simplify, Quality,
Stability, and Accountability
Implementation Goal: July 1, 2024
25Initiatives in Case Management Redesign
Included in Case Management Redesign are several initiatives:
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
A new free class for people seeking or receiving HCBS -"Speak
Up" is now available
26What is the PCBA?
• The Person-Centered Budget Algorithm (PCBA) will be a new way to
assign budget ranges for every person seeking or receiving HCBS
• It will be based on responses to questions during the new
assessment process and will be used during support planning
• It will replace current budget methods (like the Supports Intensity
Scale (SIS) Support Levels)
• It will not be implemented fully until 2023
2728
Speak Up Class
Person Driven Planning Class
• Free 10 Week Class
• Accessible to ALL people with disabilities /
follows principles of UDL
• Support staff/family welcome
• Over Zoom during COVID
www.speakupcolorado.com
Email: info@speakupcolorado.com
29Skilled Nursing Facility
Demonstration of Need
What does it do?
• This bill would create a Demonstration of Need
• A Demonstration of Need would include criteria that would need to be met for
new skilled nursing Medicaid beds or facilities to be allowed
What is the goal?
• To help manage the growth of Medicaid nursing facilities
• To increase access to care for all Coloradans
30Remote Supports for Adults in
HCBS Waivers
What does it do?
• This bill would implement a remote support option in the Home
and Community Based Services (HCBS) waivers
What is the goal?
• To improve quality of care, greater options,
and independence for members
31Key Budget Request- SLS
Flexibility
• More money to provide additional services and
supports to members on HCBS-SLS waiver who
demonstrate need
32Mutual DD/SLS
Waiver Services SLS Waiver
Services
Behavioral Services
Assistive Technology
Day Habilitation Health Maintenance
(Specialized Habilitation,
Waiver
Supported Community Activities
Connections)
Home Modifications
DD Waiver Dental Services
Services Homemaker Services
Home Delivered Meals Life Skills Training
Services
Residential Habilitation
Services (24-hour individual or Non-Medical Mentorship
group) Transportation Personal Care
Peer Mentorship Personal Emergency
Prevocational Services Response System (PERS)
Professional Services
Specialized Medical (Includes Hippotherapy, Massage &
Equipment & Supplies Movement Therapy)
Respite Services
Supported Employment
Vehicle Modifications
Transition Set Up
Vision Services
33Updates
34• Electronic Visit Verification
EVV Update (EVV) is a technology solution
used to verify that services
are delivered
• EVV must collect 6 points of
data: member, caregiver,
service, date, time, and
location
• EVV was required as of
August 3, 2020
35FMS Vendor Change
• Effective April 1, 2021, Acumen Fiscal Agent will no longer provide
Financial Management Services (FMS) for Colorado Consumer-
Directed Attendant Support Services (CDASS) members
• Members currently enrolled with Acumen must choose another FMS
vendor by February 10, 2021
• Case managers will assist members and their Authorized
Representatives with the transition to another FMS vendor
• See Operational Memo 21-010 for more information
36Day Program Update
• The Department is proposing changes to Day Habilitation
• These changes include the new 1:1 option for Specialized
Habilitation and Supported Community Connections
services
• The Department is hosting a meeting today at 11:00 am to
talk about these changes
Link: https://cohcpf.adobeconnect.com/idd/
Call-In Phone Number: 1-877-820-7831; Participant Code: 706065#
37Stay Engaged
Memos, Webinar Info, and FAQs - Updated Regularly
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
38Additional Technical Assistance:
EVV & Assessment and
Person-Centered Support Plan
February 19, 2021
1:00 – 2:00 pm
https://cohcpf.adobeconnect.com/rawuk1jw992v/
39Vaccine Confidence Webinar
Special Guest Dr. Anuj Mehta
COVID-19 Vaccine:
Reasons Not to be Afraid.
Tuesday, February 2 @ 1:00 PM
Dr. Anuj Mehta, Assistant Professor of Medicine with
https://www.telligenqinqio.com/event/covid-19-
Denver Health and Hospital Authority, will discuss why
some healthcare providers and patients are vaccine vaccine-reasons-not-to-be-afraid/
hesitant and provide answers to the following
questions:
•How does immunity work?
•What are mRNA vaccines, and should I trust them?
•What is the current data on safety and efficacy of the
40
COVID-19 vaccine?Next Webinar
Updates for Disability,
Older Adult & Advocacy
Communities
Friday, March 5, 2021
10:00 – 11:00 AM
Webinar Call-in Information:
Local: 720-279-0026 / Toll Free: 1-877-820-7831
Participant Code: 174363#
Webinar Link
412020 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 422021 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 43Questions?
44Thank you!
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