As the deadline to spend ARPA HCBS funding continues to get closer, we look forward to sharing more updates with you about projects that are wrapping up. So much work has been done and so many accomplishments achieved by the time projects get to the point of closure - hiring new staff, setting up contracts, countless meetings with external stakeholders, implementation, tracking impact and outcomes, and of course, sustainability planning so that all of the hard work and value from this rare opportunity does not go to waste.

This month we will kick things off with an exciting announcement from the Biden/Harris Administration about Colorado's Direct Care Workforce efforts. We will also focus on several projects in the Enhance Quality Outcomes category as well as provide an update on a technology project connecting case management agencies to admission, discharge and transfer data and information about a behavioral health provider technical assistance opportunity.



We hope you enjoy!

~ The ARPA Team

👀 Did you see? 👀

Biden-Harris Administration Partners with Colorado and Releases Data Recommendations to Strengthen the Direct Care Workforce

HCPF is thrilled to announce that Colorado has been selected alongside Alaska, Delaware, Indiana, New Jersey, and New Mexico to participate in two separate technical assistance programs that together will help participating states better recruit, train, and retain direct care workers, who provide home and community-based services (HCBS) for older adults and people with disabilities. 

Congratulations to the Direct Care Workforce Team!

Read more about the announcement here

✅ 8.09 - Waiver Quality Expansion ✅

Completed

Key Project Activities and/or Achievements: 

ARPA 8.09 expanded the waiver quality surveys administered by the Department of Health Care Policy and Financing (HCPF). HCPF partnered with an independent firm, Vital Research, to assist in the development and administration of two surveys, the Children's Waiver Satisfaction Survey (CWSS) and the Case Management Satisfaction Survey (CMSS). 

Summary / Project Outcome: 

Given the importance of case managers in delivering services to residents of the state of Colorado, ARPA 8.09 generated the Case Management Satisfaction Survey to obtain a better understanding of case manager's satisfaction with compensation, benefits, career advancement, training, and overall fulfillment in their positions. In addition, HCPF hoped this understanding would aid in recruitment and retention of case managers throughout Case Management Redesign. The final survey included 34 items, where case managers were asked close-ended items about their overall engagement and satisfaction in their roles. In addition, an open-ended item for additional comments was included. 

A total of 1,040 potential respondents received a survey link and three reminders to complete the survey via email. Data collection began on 10/27/2022 and was concluded on 11/21/2022​. Of the 1,040 invitations that were emailed to complete the survey, a total of 580 responses were received for a response rate of 56%. Using a 95% confidence interval, the margin of error was +/- 2.7%.

Key findings from the Case Management Satisfaction Survey:

• Most respondents had worked for their current agency for one to two years (31%) and 67% had worked as a case manager for three or more years.
• Nearly 80% of case managers are satisfied with their job and 73% are satisfied with their wages and benefits. Yet based on the open-ended comments, compensation was noted most often as an area that is a source of dissatisfaction.
• Case managers are fulfilled in their jobs. Case managers think that the work they do is important (99%), they feel a sense of accomplishment (91%) and they find their job enjoyable (82%). Yet, half of all case managers feel their work environment is very stressful and four in 10 feels emotionally drained from work. This is supported by open-ended comments where burnout, stress and morale were mentioned as contributing to case manager mental health issues.
• Case managers feel they enjoy a good amount of autonomy in their job. Case managers have lots of flexibility (94%), they feel their ideas and suggestions are valued (79%) and they believe their current work environment empowers them to accomplish their work in an effective manner (79%). On the other hand, almost two thirds (63%) of case managers believe they have too much responsibility and not enough authority.​
• When case managers were asked how likely they would be to leave their job in the next year, 37% indicated that it was somewhat or very likely. In addition, case managers are also not likely to recommend this type of work to a family, friend, or colleague.
• Over 90% of case managers like the people they work with (99%), feel respected by their co-workers (97%) and supervisor (96%) and believe their supervisor is someone they can trust (94%). Case managers also feel their work is appreciated (83%) and they are respected by upper management and leadership personnel (78%). On the other hand, nearly a third (31%) do not believe they receive adequate resources and materials to execute their assignments, which is supported by workload expectation comments that were mentioned 19% of the time by case managers.

-------------------------------------------------------

The creation of the Children's Waiver Satisfaction Survey (CWSS) was an effort to expand on the National Core Indicator’s Children’s Family Survey (NCI-CFS) which primarily focused on Colorado’s Children’s Extensive Services (CES) waiver. The new children’s survey received feedback from families and members enrolled on the four children’s waivers, which included the Children's with Life-Limiting Illness (CLLI) waiver, Children's Extensive Services (CES) waiver, Children's Habilitation Residential Program (CHRP) waiver, and Children's Home and Community Based Services (HCBS) waiver. This survey aimed to establish insights into member experience, satisfaction, and report of care needs versus the actual services received. The data will be utilized to recommend changes to the waiver programs and will serve as baseline data to track outcomes of changes in policies and programs in the future.

The project produced two children’s waiver survey instruments, one for members under the age of 18, and one for members 18+. Surveys consisted of 48 items for those under age 16 and 52 items for 16-17-year-olds related to the following topics:

• Accessing + Understanding Child’s Waiver Program
• Case Management + Service Planning
• Child’s Services + Supports
• Family Needs + Supports
• Transition Needs for Young Adults (only answered by those whose children were age 16-17)
• Health Insurance + Other Benefits
• Demographics

The surveys launched in August 2023 and data collection closed in October 2023. 5,259 families enrolled on the Home and Community Based Services (HCBS) children's waivers were sent surveys via mail, and 2,392 families received the survey via email in addition to the mailed survey. 941 surveys were completed and used for analysis; 573 were received by mail, and 361 were received online. Using a 95% confidence interval, the margin of error was +/- 2.9%.

Key findings from the Children's Waiver Satisfaction Survey:



• Generally, results for case management were positive. 90% of respondents reported case managers were responsive to their requests. 89% of respondents were very​ satisfied or somewhat satisfied with their case manager. 98% of respondents reported their case manager respects their family’s choices and opinions. 46% of families did not experience any turnover in their case manager during the year prior to when surveys were completed.
• All respondents were asked if they had received a copy of their child’s service plan. While 68% of respondents had received a copy of the service plan, 32% had not or did not know if they had received a copy.
• All survey respondents were asked to rate the overall quality of the services and supports their family receives on their waiver program. Eighty-three percent of respondents rated the quality of their services and supports as either excellent or good. Just 17% of respondents felt their services and supports were fair or poor. 

Read this report anytime on the ARPA Website

🔜 8.08 - HCBS Quality Dashboards 🔜

Coming Soon

HCPF conducts Member experience surveys each year, called National Core Indicators (NCI) surveys. These surveys are completed by members who are enrolled in HCBS waivers. There are 4 versions of the NCI surveys:

• NCI-AD: Aging and Disabilities HCBS waiver participants
• NCI-IDD: Intellectual and Developmental Disabilities HCBS waiver participants
• CWS: Children’s Waiver Services HCBS waiver participants
• State of the Workforce: Direct Care Workforce providers

The purpose of these surveys is to understand member experiences with HCBS, address gaps to improve programs, ensure quality of services, and gather required HCBS Measure Set Data. The survey responses and outcomes are currently reported annually, but these reports are lengthy and contain a lot of industry information and jargon, making the reports less digestible for members, families, and other community members.  

ARPA 8.08 is creating accessible, user-friendly HCBS Quality Dashboards to share the NCI survey member experience responses and State of the Workforce provider responses.  These dashboards will be interactive, filterable by defined service area, year, and waiver. These dashboards will house the data for the previous 3 years of NCI survey responses and provide a tool to pull reports, recognize gaps in services, and provide valuable information regarding the overall health of CO HCBS services. HCPF hopes to continue adding data for subsequent survey cycles to help evaluate trends over time.

Look for announcements in future ARPA and OCL Newsletters for when these new dashboards are available this summer!

Grant Update:

6.13 Connect Case Management Agencies (CMAs) to Admission, Discharge, and Transfer (ADT) Data Pilot

Grant Purpose & Achievements:



HCPF created a grant-funded pilot opportunity for Home and Community Based Services (HCBS) Case Management Agencies (CMAs) to support the provision of Admission, Discharge, and Transfer (ADT) data. The goal of the pilot was to improve care coordination and timely critical incident reporting to better support Health First Colorado members. 

Stakeholder feedback informed HCPF’s development of policies and procedures for utilizing new data as part of current practices, as well as best practices and lessons learned from the pilot. As a result of having access to ADT data, case managers were able to better coordinate care and participate in discharge planning. Overall, this improved health outcomes and the quality of care for Health First Colorado members. 

Conclusion/Outcomes:

Case managers benefited from knowing when members had been hospitalized, alerted them to possible changes in functional needs and services and supports, as well as possible critical incidents. Case managers were able to better coordinate care and participate in discharge planning with access to this information.

Given the positive feedback from having access to this data, HCPF submitted a system change request to generate ADT notifications and a work queue in the Care and Case Management (CCM) system.

Summary of Funding

7

CMA grantees, January 2023-December 2023

$103,544 Total spend

Funding used for:

• Personnel: staff time spent distributing ADT data
• Systems Implementation: software and hardware for case managers utilizing ADT data
• Operations: business processes and systems costs related to utilizing ADT data

Reminder:

Training Fund Grants Open for Individual Direct Care Workers and HCBS Providers 

HCPF is offering short-term grant funding to incentivize and expand training opportunities for the Home and Community-Based Services (HCBS) workforce. The grants will fund higher-level skills that will promote greater retention within the HCBS workforce. The maximum award amount per application for direct care workers is $500 and for HCBS providers is $100,000.

Eligible applicants include:

• Individual, age 18 or older, who is currently working in a direct care role within any of Colorado’s Home & Community-Based Service (HCBS) Waivers; or
• Individual, age 18 or older, who desires training to enter direct care within Colorado’s HCBS Waiver workforce; or
• Also included within this workforce, are Certified Nurse Aides and Home Health Aides within Long-Term Home Health; or
• Currently enrolled Home and Community-Based Services (HCBS) waiver providers; and
• Training vendor/provider that develops/delivers training/specialization for the HCBS workforce. 

Interested in learning more about how this grant could support higher-level skills for the HCBS workforce?

Visit the grant program information page to get more details and apply.

Applications are open now!

Questions? Email us at hcpf_dcworkforce@state.co.us .

Update: ARPA May Quarterly Webinar Format

In an effort to respect all of our stakeholders' busy calendars and to try a new format, the originally scheduled quarterly update webinar on May 16th will be pre recorded and released via YouTube instead of a live presentation. Look for an email this month sharing the recording!

- - - -

Community First Choice (CFC) Council Meeting

The CFC Council is in place to collaborate with and advise the Colorado Department of Health Care Policy and Financing (HCPF) on the design and implementation of a CFC option in Colorado. Primarily made up of individuals with disabilities, those 65 years or older, and their representatives, the council’s experience and expertise will help ensure that CFC is implemented in a way that best meets the needs of Coloradoans with disabilities.

Agendas, presentations, and other related materials for council meetings can be found on the CFC Stakeholder Opportunities webpage.

For more information, contact the CFC team at HCPF_CFC@state.co.us.

The meeting will be held:

Wednesday, May 1, 10 to 11:30 a.m. MT

Meeting topic:

New Licensure Requirement for Personal Care Service Providers under Community First Choice

Join via Google Meet

Join via Phone:

1-260-230-1249, PIN: 719 313 221#

- - - -

Direct Care Workforce Collaborative (DCWC) Training & Career Advancement Action Group

This Action Group works collaboratively with stakeholders to identify and move forward strategies to support the recruitment and retention of Colorado's direct care workforce. This group intends to meet every other month on the first Friday of the month from 9 to 10 a.m. MT. For more information, please see the Direct Care Workforce Collaborative webpage, or email HCPF_DCWorkforce@state.co.us.

The meeting will be held:

Friday, May 3, 2024

9 to 10 a.m. MT

Join via Zoom

Join via Phone:

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

Meeting ID: 969 4053 6000, Passcode: 115140

- - - -



ARPA 1.05 Provider Informational Webinar Series

This final webinar will provide information to prospective applicants about the ARPA 1.05 Provider Grant. The intention of this grant is to provide more training opportunities and incentives for workers to gain higher-level skills that would promote greater retention within the HCBS workforce. This webinar will review the grant eligibility and application process. All interested stakeholders are welcome.

More information will be posted on the ARPA 1.05 webpage. If you have any questions, email HCPF_DCWorkforce@state.co.us.

The webinar will be held:

Tuesday, May 7, 2024, 11 a.m. to 12 p.m. MT

Join via Zoom

Join via Phone:

(Toll-free) 877-853-5257

Meeting ID: 993 1700 7314, Passcode: 396389

- - - -

DCWC Compensation and Benefits Action Group

This Action Group works collaboratively with stakeholders to identify and move forward strategies to support the recruitment and retention of Colorado's direct care workforce. This group intends to meet every other month on the third Friday from 10 to 11 a.m. MT. For more information, please check out the DCWC webpage, or email HCPF_DCWorkforce@state.co.us.

The meeting will be held:

Friday, May 17, 2024

10 to 11 a.m. MT

Join via Zoom

Join via Phone:

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

Meeting ID: 993 1700 7314, Passcode: 396389

- - - -

Criminal and Juvenile Justice Collaborative (Virtual and In-person) Meeting Series

The HCPF Criminal and Juvenile Justice Collaborative provides ongoing feedback to ensure robust stakeholder participation in the development of criminal justice projects including:

• ARPA 8.10 - Criminal Justice Partnerships
• Consolidated Appropriations Act (CAA) - Juvenile Justice
• 1115 Re-entry Waiver

The Collaborative meets on the fourth Wednesday of the month at 1 to 2 p.m. MT. The April 2024 meeting will be held at 303 E. 17th Ave., Conference Room 11AB, Denver, CO 80203. The location of future meetings - May 2024 and beyond - is to be determined.

The next meeting will be held:

Wednesday, May 22, 2024

1 to 2 p.m. MT

In-person meeting location for the May meeting:

303 E. 17th Ave., Denver, CO 80203

Virtual meeting access:

Join via Zoom

Join via Phone:

(Toll-free): 877-853-5257

Webinar ID: 895 8171 8788, Passcode: 011267

For more information about the Collaborative and its meetings, including location, please see the Criminal and Juvenile justice collaborative webpage. For any questions, please email Hannah Hall.

- - - -

Direct Care Workforce Collaborative (DCWC) Value and Awareness Action Group

This Action Group works collaboratively with stakeholders to identify and move forward strategies to support the recruitment and retention of Colorado's direct care workforce. This group intends to meet every other month on the fourth Friday of the month from 1 to 2 p.m. MT. For more information, please check out the Direct Care Workforce Collaborative webpage, or email HCPF_DCWorkforce@state.co.us.

The meeting will be held:

Friday, May 24, 2024

1 to 2 p.m. MT

Join via Zoom

Join via Phone:

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

Meeting ID: 969 4053 6000, Passcode: 115140

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.us or the 504/ADA Coordinator at hcpf504ada@state.co.us at least one week prior to the meeting to make arrangements.