Updates for Disability, Older Adult & Advocacy Communities - April 2, 2021 (HCPF)
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Updates for Disability, Older Adult
& Advocacy Communities
Colorado Department of
Health Care Policy & Financing
(HCPF)
April 2, 2021
Overview
Health Care Policy & Financing
• Bonnie Silva, Office of Community Living Director, HCPF
• Marivel Klueckman, Eligibility Division Director, HCPF
• Rachel Reiter, External Relations Division Director, HCPF
Colorado Cross Disability Coalition
• Julie Reiskin, Executive Director
2
Colorado Crisis Services Boulder Supermarket Shooting
coloradocrisisservices.org Several funds have been set up in support of
the victims of the Boulder shooting and their
families. Please visit any of these links for
National Disaster Distress more information:
Helpline boulderoem.com/donations
1-800-985-5990 commfound.givecorps.com
www.coloradohealingfund.org
3
Teri Leiker
1969-2021
Daughter, Lover,
Athlete, Friend,
Employee,
Coworker, Fan,
Volunteer, Karaoke
Participant,
Boulderite, Proud
Disabled Woman
4
COVID-19 Updates
22
Residential Care Settings Visitation
• New guidance released March 23, 2021
• Allows for increased and more
meaningful visitation for residents who
have been vaccinated
• Residential Care Facility Comprehensive
Mitigation Guidance document released
- One source for information
6
Residential Care Settings Data
7
Residential Care Settings Data
8
Homebound Vaccine Outreach
Homebound Persons are those who never or rarely left the home in
the past month. The reason a person is homebound may be physical,
psychological, or cognitively related.
Predictors:
• Serious memory loss
• Being older
• Having more chronic conditions
• Taking more prescription medications
• Having multiple hospitalizations
9
Homebound Vaccine Outreach
Proactive Outreach:
• Direct outreach to identified individuals
through case management agencies and
Regional Accountable Entities
• Outreach includes three goals:
Provide information about how to get the
vaccine
Help coordinate support (ex. transportation)
Confirm Coloradans who are homebound
10Homebound Vaccine Outreach
Timeline
Phase 1.B.1 - 1.B.4 no
later than April 9, 2021
Phase 2 and ongoing
by April 23, 2021
11Homebound Vaccine Outreach
Next Steps:
Formalize non-Medicaid outreach plan
Finalize homebound vaccine distribution
Identify counties that have already developed
local solutions and determine process for working
in tandem with these organizations
12Homebound Vaccine Outreach
Question: If I am a Medicaid member and homebound
and need support getting the vaccine at home, what do I
do to get help?
Answer: Call your Case Manager or the Regional
Accountable Entity (RAE) for your region. To determine
your RAE, find your county here:
https://hcpf.colorado.gov/accphase2
13Homebound Denver Residents
* Through Denver Department of Public Health & Environment
18 or older with one or more
high-risk condition and
required to stay at home for Sign up by calling Denver Department of Public Health
and Environment at 720-865-3005 and press Option 4
health and safety reasons
for at-home vaccination.
Live within the City and This service is available in English and Spanish, as well as
County of Denver other languages through a phone interpreter.
Please note: This service is available for individuals who
Eligible to receive your are required to stay at home for health and safety
vaccine according to Colorado reasons, as well as one primary care-giver at the same
Department of Public Health address. The primary care-giver is eligible under
and Environment (CDPHE) Colorado’s Phase1B as a home health provider, and does
not need to present any credentials or certification.
guidance FLYER
14Office of Community Living
Updates
15Eligibility Update - Members
• We’re driving improvements to our systems and with our
counties, so our applicant and members’ experience when
applying for benefits and receiving benefits is positive
• We’ve implemented new programs that can help address
concerns we’ve heard from you about your county
experience
• We’re working to address county-specific
challenges for Long-Term Services and
Supports applicants and members
16Eligibility Update - Members
• The COVID-19 pandemic resulted in many systems and policy
changes, but this allowed us to better support Coloradans through
these challenging times
• We continued our work to improve our systems to better serve
applicants and members, including PEAK. An improved online
experience and better self-service tools removes the need to
request services in-person
• We’re working to address eligibility-specific
challenges for Long-Term Services and Supports
applicants and members
17American Rescue Plan Act
• 10% Increased FMAP (federal funding match)
• Targeted to Home and Community Based Services
Includes Case Management
• Timeline: April 1, 2021 - March 30, 2022
• Working with stakeholders to determine the best approach for
using these funds to move forward key priorities
• Currently waiting on CMS guidance and additional information
18Legislative Updates
Skilled Nursing Facility Demonstration of Need
Sponsors: Rep. Lontine and Senator Fields
Case Management Redesign
Sponsors: Rep. Young, Rep. Pelton, Senator Winter, and
Senator Rankin
19Nursing 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
An example of a requirement could be that there must be enough people over a certain
age within a community to justify a new facility
• Allows for private nursing facilities to have up to 5 Medicaid beds and be paid at
the state-wide average rate
What is the goal?
• To help manage the growth of Medicaid nursing facilities
• To increase access to care for all Coloradans
20Case Management Redesign
Legislation
Legislation to support Case Management
Redesign (HB21-1187) passed out of the
House this week and should be introduced in
the Senate next week
Includes changes to case management
agencies that will go into effect July 1, 2024
Legislation requires the Department to work
with stakeholders and release a timeline for
system changes by December 31, 2021
21Initiatives in Case Management Redesign
Included in Case Management Redesign:
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)
To learn more, or to get involved, visit our website
22Other Legislation
• HB 21-1110 (ADA Title 2)
• HB 21-1122 (Law Enforcement)
• HB 21-1199 (Right to Repair) LOST
• SB 21-039 (SMW)
• SB 21-107 (Carrie Lucas)
• SB 21-182 (School discipline)
• SB 21-188 (Ballot access)
• Good housing bills
• Bad voter suppression bills
Check out bills supported and opposed by
CCDC on our website www.ccdconline.org
23National Core Indicator (NCI) Survey
• The National Core Indicators (NCI) HCBS surveys
will return this spring (suspended last year due to
the public health emergency)
• Colorado has been participating in this national
survey tool since 2013.
• Colorado residents who receive long-term services
and supports may be randomly selected to
participate in an NCI Survey.
• The NCI survey provides an opportunity for
members who receive HCBS to report their
satisfaction with their services and level of
community integration.
• This year’s survey will be conducted remotely.
24Emergency Broadband Benefit
• Available through the FCC for households
struggling to pay for internet
• Benefit may include:
Up to $50/month towards broadband service
Up to $75/month for households on Tribal lands
One-time discount of up to $100 to purchase a laptop, desktop, or tablet if
they contribute $10-$50 toward the purchase price
• Start date to be announced soon, visit the FCC website for more
information
25Updated
Website Look
Aligns with other state
agency sites
Old links should continue
working
Improved navigation
features
If you notice anything
missing or not working,
let us know!
HCPF_HCBS_Questions@state.co.us
2660 Second
Satisfaction
Survey
www.surveymonkey.com/r/commweb
27How to Stay Engaged
28Stay Engaged
Stakeholder hcpf.colorado.gov/OCL-stakeholder-engagement
Engagement Page
hcpf.colorado.gov/office-community-living-update-
OCL Webinar Page webinars
2021 Memos Series hcpf.colorado.gov/2021-memo-series-communication
Email us HCPF_HCBS_Questions@state.co.us
Subscribe to a Click here to subscribe
Newsletter
29Next Webinar
Updates for Disability,
Older Adult & Advocacy
Communities
Friday, May 7, 2021
10:00 – 11:00 a.m.
Webinar Call-in Information:
Local: 720-279-0026 / Toll Free: 1-877-820-7831
Participant Code: 174363#
Webinar Link
302021 Guidance
Case Management Agencies HCBS Providers
CDASS FMS Transition Notification LTSS Transition to Telligen for
OM 21-010 UR/UM
EVV Timeline Update Indiv. Service Addition to
Day Hab. Svcs.
•
• OM 21-017 • OM 21-007
Updated CM Opp Changes in
Response to COVID-19 Homebound Vaccine Outreach • OM 21-020 • OM 21-025
• OM 21-013 • OM 21-031
• OM 21-024
Informed Consent Template for
Participant Directed Pgms UR/UM Rights Modifications
Changes to Benefits and Changes to CDASS Criminal
• OM 21-014 • OM 21-032 Services Rates in Response Barriers Crime List
to COVID-19 • OM 21-027
• OM 21-009 Changes to HCBS Rates in
Facilities and PACE Response to COVID-19
PACE Participant Adverse New PASRR Vendor Operational changed to • OM 21-034
and Expedited Appeals • OM 21-0016
• OM 21-006
NEMT for COVID-19
• OM 21-012
Temporary Rate Increase
for NF, ICF, RC
• OM 21-008
All 2021 Guidance can be found here: hcpf.colorado.gov/2021-memo-series-communication 31Questions?
32Thank you!
33Provider Update and Technical
Assistance
Colorado Department of
Health Care Policy & Financing
(HCPF)
April 2, 2021
1Overview
Health Care Policy & Financing
• Bonnie Silva, Office of Community Living Director, HCPF
• Amanda Lofgren, Case Management and Quality Performance
Division Director
• Marivel Klueckman, Eligibility Division Director
• Rachel Reiter, External Relations Division Director
2COVID-19 Updates
22Residential Care Settings Visitation
• New guidance released March 23, 2021
• Allows for increased and more meaningful visitation
for residents who have been vaccinated
• Residential Care Facility Comprehensive Mitigation
Guidance document released - One source for
information
37Residential Care Settings Data
38Residential Care Settings Data
39Homebound Vaccine Outreach
Homebound Persons are those who never or rarely left the home in
the past month. The reason a person is homebound may be physical,
psychological, or cognitively related.
Predictors:
• Serious memory loss
• Being older
• Having more chronic conditions
• Taking more prescription medications
• Having multiple hospitalizations
40Homebound Vaccine Outreach
Proactive Outreach:
• Direct outreach to identified individuals
through case management agencies and
Regional Accountable Entities
• Outreach includes three goals:
Provide information about how to get the
vaccine
Help coordinate support (ex. transportation)
Confirm Coloradans who are homebound
41Homebound Vaccine Outreach
Timeline
Phase 1.B.1 - 1.B.4 no
later than April 9, 2021
Phase 2 and ongoing
by April 23, 2021
42Homebound Vaccine Outreach
Next Steps:
Formalize non-Medicaid outreach plan
Finalize homebound vaccine distribution
Identify counties that have already developed local
solutions and determine process for working in tandem
with these organizations
43Homebound Vaccine Outreach
Question: If I am a Medicaid member and homebound and
need support getting the vaccine at home, what do I do to
get help?
Answer: Call your Case Manager or the Regional
Accountable Entity (RAE) for your region. To determine
your RAE, find your county here:
hcpf.colorado.gov/accphase2
44Office of Community Living
Updates
22Eligibility Update - Providers
• As an agency, the Department is responsible for statutory,
administrative and eligibility oversight of county departments of
human/social services for the Medicaid Program
• The county or eligibility site is responsible for processing initial
applications and the county is responsible for ongoing case maintenance
• Providers are impacted when an eligibility determination is not
completed timely or accurately or when the applicant or member
cannot get their questions answered
• Providers may not be able to bill for services if the eligibility
determination was not timely or accurate
46Eligibility Update - Providers
• Colorado is a geographically, demographically and economically
diverse state
• Counties pay a portion of all costs they incur locally for the
Medicaid program resulting in some inequities and variations in
the system
• That requires HCPF to conduct thorough oversight, but our
previous structure, before our Oversight and Accountability
Initiative, wasn’t conducive to that type of oversight
47Eligibility Update - Providers
This year, we implemented our Oversight & Accountability Initiative. This
initiative creates a structure that allows us to be responsive to applicants and
members and be compliant with federal and state requirements.
Components of the Initiative include:
Contract revisions that focus on timely and accurate outcomes and Access to Care
Conducting verified, on-site compliance reviews of all eligibility sites on a three-year
cycle, implementing corrective action plans and providing targeted technical
assistance
Accountability dashboards for all eligibility sites and the state, with robust
performance measures
Conducting monthly eligibility determination reviews for accuracy with accuracy
measures on dashboards and data to identify training needs
48Eligibility Update - Providers
• Over the past year, our Eligibility teams have been hard at work
implementing systems changes, issuing guidance and adding supports
for applicants and members as Colorado families were devastated by the
effects of the COVID-19 pandemic.
• Simultaneously, we implemented our Oversight & Accountability
Initiative. As part of the Initiative, we specifically focused on Long-
Term Services and Supports processing, to better support these
vulnerable populations.
• This work can also positively impact providers by ensuring timely and
accurate eligibility determinations.
49Eligibility Update - Providers
• Late 2020: LTSS process mapping from the application perspective
• HCPF also hosted a pain point conversation with Eligibility Sites to gather
pain points in the LTSS eligibility determination process
• From the pain points, some countermeasures were developed or were
previously in process
Countermeasures are actions taken to mitigate the pain point, such as a systems
change or improvement
• What did we find as pain points?
Eligibility system processes for LTSS are largely manual, causing delayed
determinations. These require future systems and policy countermeasure solutions
to automate the process to drive greater accountability
50Eligibility Update - Providers
• HCPF also completed a data analysis of early 2021 untimely determinations
and redeterminations to find the root cause of the delayed action
• In this analysis, we found that there are opportunities for the Department
and its contractors to make improvements to increase timely
applications. Eligibility sites and case management agencies also have
opportunities for improvement.
• We believe these actions will help address applicant and member concerns
around delayed decisions, as well as assist providers in getting payment for
those truly eligible
51Changes To Day Programs and NMT Rates
In Response To COVID-19
• Rate changes effective 3/23/2021
Retroactively applied to 7/18/2020 (end of retainer payments)*
Extend to 6/30/2021
• The rate increases will be as follows:
July 18, 2020 – December 31, 2020: 27.4%
January 1, 2021 – March 31, 2021: 37.4%
April 1, 2021 – June 30, 2021: 27.4%
• Information on the services to which the temporary rate increases apply, as
well as instructions on how to bill – OM 21-034
• Rate increases are in addition to the enhanced rates published in OM 21-009
*Does not apply to new 1:1 Day Hab Service 52American Rescue Plan Act
• 10% Increased FMAP (federal funding match)
• Targeted to Home and Community Based Services
Includes Case Management
• Timeline: April 1, 2021 - March 30, 2022
• Working with stakeholders to determine the best approach for
using these funds to move forward key priorities
• Currently waiting on CMS guidance and additional information
53EVV Timeline Update
• No date picked out yet
Checking weekly on numbers
• Can continue to delay claims edit per CMS
• Current primary focus is avoiding undue hardship to
providers during COVID
• Will identify a date this spring and begin letting providers
know (at least a month in advance)
54Travel Time Analysis Update
• Currently receiving data
Need at least 3 months of run out time
• HCPF Policy and Data teams currently meeting
to discuss preliminary findings
55Case Management Redesign
Legislation
Legislation to support Case Management
Redesign (HB21-1187) passed out of the
House this week and should be introduced in
the Senate next week
Includes changes to case management
agencies that will go into effect July 1, 2024
Legislation requires the Department to work
with stakeholders and release a timeline for
system changes by December 31, 2021
56Initiatives in Case Management Redesign
Included in Case Management Redesign:
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)
To learn more, or to get involved, visit our website
57Case Management Redesign
Upcoming Work
Focused work currently underway:
• Case management (CM) catchment area analysis
• Determination of Medicaid authority
• Re-evaluation of Rural Exceptions (“only willing Meeting materials
and qualified provider”) and other
• Organized Health Care Delivery System (OHCDS) information on new
analysis CMRD webpage
• Human Rights Committee (HRC) analysis
• Quality case management research
• Development of Final Report
3760 Second
Satisfaction
Survey
www.surveymonkey.com/r/ProvUpWeb
59How to Stay Engaged
38Stay Engaged
Stakeholder hcpf.colorado.gov/OCL-stakeholder-engagement
Engagement Page
hcpf.colorado.gov/office-community-living-update-
OCL Webinar Page webinars
2021 Memos Series hcpf.colorado.gov/2021-memo-series-communication
Email us HCPF_HCBS_Questions@state.co.us
Subscribe to a Click here to subscribe
Newsletter
61Upcoming Events or Actions
Direct Care Workforce Collaborative
• Next Meeting: April 14th from 10am-11:30am
• Discussion Topic: Addressing low compensation
HCBS Settings Final Rule
• State codification of federal rule
Heading into formal public notice + comment rulemaking process soon
• Updated informed consent template
ForCMAs and Provider Agencies to obtain Member’s informed consent to
a Rights Modification: Operational Memo HCPF OM 21-032
62Updated
Website Look
Aligns with other state
agency sites
Old links should redirect
indefinitely
Improved navigation
features
If you notice anything
missing or not working,
let us know!
HCPF_HCBS_Questions@state.co.us
63Next Webinar
Provider Updates and
Technical Assistance
Friday, May 7, 2021
1:00 – 2:00 p.m.
Webinar Call-in Information:
Local: 720-279-0026 / Toll Free: 1-877-820-7831
Participant Code: 174363#
Webinar Link
422021 Guidance
Case Management Agencies HCBS Providers
CDASS FMS Transition Notification LTSS Transition to Telligen for
OM 21-010 UR/UM
EVV Timeline Update Indiv. Service Addition to
Day Hab. Svcs.
•
• OM 21-017 • OM 21-007
Updated CM Opp Changes in
Response to COVID-19 Homebound Vaccine Outreach • OM 21-020 • OM 21-025
• OM 21-013 • OM 21-031
• OM 21-024
Informed Consent Template for
Participant Directed Pgms UR/UM Rights Modifications
Changes to Benefits and Changes to CDASS Criminal
• OM 21-014 • OM 21-032 Services Rates in Response Barriers Crime List
to COVID-19 • OM 21-027
• OM 21-009 Changes to HCBS Rates in
Facilities and PACE Response to COVID-19
PACE Participant Adverse New PASRR Vendor Operational changed to • OM 21-034
and Expedited Appeals • OM 21-0016
• OM 21-006
NEMT for COVID-19
• OM 21-012
Temporary Rate Increase
for NF, ICF, RC
• OM 21-008
All 2021 Guidance can be found here: hcpf.colorado.gov/2021-memo-series-communication 65Questions?
47Thank you!
48You can also read
