We hope everyone had a relaxing and enjoyable Memorial Day weekend. In this edition of the ARPA Project Pulse, we will feature the category Strengthen Case Management Redesign. Within this category are a number of important projects that will prepare the long-term services and supports case management system for the big and exciting changes that lie ahead.

The transformation of Colorado’s case management system is underway, requiring a complete reorganization of a decades-old system. As the case management system adapts and transforms, the Department is focusing on ways it can support case management agencies for the upcoming changes and growing pains that may come along with them. To assist with expected organizational and system changes, the Department is assisting agencies in a number of ways with ARPA funding such as capacity-building funds, change management expertise, and evolving systems of support for agencies, members, and their families.

Case Management Redesign refers to several initiatives that will help make accessing long-term services and supports (LTSS) easier by changing case management agencies to serve all Home and Community-Based Service (HCBS) waivers so people have one place to go. The redesign process will also ensure that there are the right number of case management agencies in Colorado to meet demand and will focus on increasing the quality of case management services.

Single Entry Points (SEPs), Community Centered Boards (CCBs), and private Case Management Agencies currently provide case management for individuals with disabilities who participate in the Colorado Department of Health Care Policy & Financing’s (the Department) 10 HCBS waiver programs. Each agency type serves different waiver programs, creating silos.

In addition to case management services, many Case Management Agencies (CMAs) also provide direct services to program recipients, creating a conflict of interest that is no longer allowable by the Centers for Medicare and Medicaid Services (CMS). This federal requirement to separate case management and direct services is called Conflict-Free Case Management.

Individuals who are seeking or receiving LTSS often qualify for multiple programs and end up navigating between systems that are divided by program, making the system difficult for members.

Case Management Redesign is intended to simplify access and remove silos so members can more easily navigate and find the right programs and services that work for them. It will require one case management agency to provide case management services for all waiver programs in each region (or “catchment area”). This change will also create consistency in the quality, accountability and stability of the case management services people receive across the state. It will allow the Department to provide oversight and support to ensure a high-performing case management system statewide.

These changes will also meet the federal Conflict-Free Case Management requirement and allow the Department to ensure quality case management services for members across the state.

In 2014, CMS, the Department’s federal partner, released the “HCBS Settings Final Rule.” It included many requirements for providers to make changes to their processes to increase person-centeredness.

This rule also included a requirement for case management agencies to be “conflict free,” which means that they cannot provide services to the same person they are providing case management services to. Colorado risks losing 50% of the budget for HCBS (federal funding) if we do not come into compliance with Conflict-Free Case Management by July 1, 2024. This would mean less people in Colorado being able to access these vital services in the future.

Additionally, Colorado’s population is changing. The state has the second fastest aging population in the country and with individuals living longer, many have multiple chronic conditions that make their needs more complex. To meet the needs of the changing demands of members, it is critical that the system be modernized.

Case Management Redesign work is already underway. We hope that you can join us in this effort! The work is projected to continue until July 2024 when the newly designed system will be in place. You can view a fully interactive timeline of the project, including all the various components, on the Case Management Redesign website.

Members will receive case management services from the agency that holds the contract in their catchment area except for in cases where both the individual and agency agree to other terms.

If a person wants to be served by another agency in an adjacent catchment area, if both the individual and the agency agree, this will be allowable.

The first session in April focused on Change Management. The next session in May focused on grant writing. 

Part 1 of this three-part series, centered on listening and learning directly from people with disabilities and their advocates, who provided their insights and talked about what CMAs will need to know about working with people with disabilities. The presentation and recording for Part 1 are posted on the CMRD webpage. 

Part 2 will take place on June 7 and focus on learning from Older Adults. Information about the meeting is on the CMRD webpage. 

Finally, Part 3 of the series, titled Balancing Equity and Unique Needs, will take place on July 26. It will feature national experts in person-centered thinking and equitable approaches to working with different populations. Information about the meeting is on the CMRD webpage.

Since the project began in October 2021, case management agencies have been completing a comprehensive case management activity time analysis until June 2, 2022. This valuable work will further the evaluation of Colorado’s case management rates.

The Department is currently undergoing an internal analysis of existing case management training materials to build a new training structure that will be available for case managers through the new LMS. Key foundational training materials are being developed at this time. 

This project will work with stakeholders to identify solutions to barriers to long-term care eligibility, both from a physical eligibility and a financial eligibility perspective. Any changes will result in the need for system enhancements as well as training for counties, Medical Assistance sites, and case managers on eligibility requirements for waiver programs and other long-term care programs. Recruiting for the Department staff associated with this project is in process.

To see all the meetings listed below on a calendar or to find meeting materials and recordings from previous ARPA-related Stakeholder Engagement, visit the ARPA Stakeholder Engagement webpage anytime.

The CFC Council collaborates with and advises the Department on the design and implementation of a CFC option in Colorado. The CFC Council consists primarily of individuals with disabilities, those 65 years or older, and their representatives to help ensure CFC is implemented in a way that best meets the needs of Coloradans with disabilities.

 

All interested stakeholders are welcome. CFC Council meetings will be held on the first Wednesday of each month from 10 a.m. - 12 p.m., from May 2022 to May 2023. These meetings are open to the public.

 

The meeting agenda, presentation, and any other meeting materials will be placed on the OCL Stakeholder Engagement page.

Prior Meeting Materials:

If you were not able to attend last month’s CFC Council meeting, held on May 4, you should review the materials listed below:

If you need assistance accessing the meeting webinar link or call-in number, contact the CFC team. For more information, see the Community First Choice Stakeholder Opportunities webpage.

Wednesday, June 1, 2022

10 a.m. - 12 p.m. MT

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The Department’s Medicaid Operations Division will be hosting a live webinar to assist providers with billing the temporary 2.11% rate increase, which utilizes Home and Community-Based Services (HCBS) American Rescue Plan Act (ARPA) funding. (See Operational Memo OM 22-010 for background information on the rate increase.)

The webinar will offer a walk-through of how to adjust claims and will provide opportunity for questions. Please submit any questions you have by completing this form.

Note: The webinar will be recorded.

 

 

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The Department is looking for input from nursing facilities!

We are seeking input from stakeholders who represent nursing facilities in Colorado on a set of topics ranging from outcome-based payments, use of revenue from provider fees, incentives for new technology and safety for nursing facility residents, and rural facilities sustainability.

 

Please register for only one of these three virtual stakeholder meetings:

 

Tuesday, June 7, 2022

9-11 a.m. MT

 

Friday, June 10, 2022

9-11 a.m. MT

 

Wednesday, June 15, 2022

1-3 p.m. MT

 

If you have questions, please contact Richard Clark.

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Through the Direct Care Workforce Collaborative meeting, the Department works collaboratively with stakeholders to identify and move forward strategies to support the recruitment and retention of Colorado's direct care workforce. All interested stakeholders are welcome.

Further information is on the Direct Care Workforce Collaborative webpage.

Wednesday, June 8, 2022

10-11:30 a.m. MT

(Toll-free) 1-877-853-5257

Meeting ID: 993 1700 7314, Passcode: 396389

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This Learning Collaborative is Part II of a three-part series focused on listening and learning directly from the individuals whose lives are most impacted by case management services. It will feature older adults and their advocates talking about what they believe is most important for Case Management Agencies to know about serving them. This webinar is open to the public but will be most helpful for staff and leaders from CMAs not currently serving older adults.

Interested stakeholders will include members of the public, case managers, older adults, and families.

Meeting information will be posted on the Department’s Case Management Redesign webpage.

Tuesday, June 21, 2022

1-2:30 p.m. MT

(Toll-free) 1-877-853-5257

Meeting ID: 952 3788 3839, Passcode: 690330

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Reasonable accommodations will be provided upon request for persons with disabilities. Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Please notify John Barry at 303-866-3173 or John.R.Barry@state.co.usor the 504/ADA Coordinator athcpf504ada@state.co.us at least one week prior to the meeting to make arrangements.