New Case Management Related Memos | |
|
Find all memos on the Memo Series web page.
OM 24-050 Group Employment Setting Definition
This memo defines group employment settings for members in HCBS-DD, HCBS-SLS, and State-SLS. Additionally, effective Feb. 1, 2025, case managers shall no longer authorize Job Coaching- Individual in a group employment setting.
OM 24-053 Admission, Discharge, and Transfer Event Notifications in the Care and Case Management System
This memo gives guidance on how case managers are to utilize ADT notifications generated within the Care and Case Management (CCM) system.
OM 24-054 2025 Social Security Cost of Living Adjustments
This memo notifies that effective Jan. 1, 2025, SSI benefits will increase by 2.5% for the year subsequently Social Security income and income trust limits will be adjusted.
OM 24-055 Case Management Agency and Case Manager Roles and Responsibilities
This memo outlines case managers’ roles and responsibilities in performing case management activities. Case managers must review and attest within the LMS by Jan. 15, 2025. Case managers hired after Jan. 1, 2025, must review and attest within 120 days of their employment start date.
OM 24-056 Long-Term Care and Buy-In Eligibility Extension
This memo notifies that effective Jan. 1, 2025, based on the member’s financial redetermination, members on LTC, WAwD, and CBwD Medicaid being terminated will receive a 60-day extension (in most cases).
OM 24-057 Developmental Disability Waiver Reserved Capacity Enrollments
This memo outlines case manager requirements for requesting member enrollment into HCBS-DD.
IM 24-031 2025 Room and Board and Personal Needs Allowance Changes
This memo notifies that effective Jan. 1, 2025, R&B will increase to $797 and PNA minimum will increase to $170.
| |
|
HCPF regularly updates the Case Management Q and A web page. New questions added in November 2024, are highlighted below.
Program Specific Questions
-
Q: If we are no longer required to complete LOCs for members accessing LTHH only, what are we supposed to do for the members that are currently “open” under LTHH in the CCM that we track to complete CSRs for? (11/26/24)
-
A: For members who currently only have LTHH programs in the CCM and no other programs or records being managed/maintained in the CCM, e.g., waiting list, FSSP, etc, you can close the program card by updating the “Program Status” field to “Closed,” entering the [effective date] (See Operational memo OM 24-049) in the “Program Closure Date” field, selecting “Other” in the “Reason for Program Closure” dropdown field, and documenting the reason in the “Other Closure Reason” field. Then the user will remove themselves from the member’s Care Team (and any other staff from the current CMA) and remove the current CMA from the Care Provider Screen using the [effective date] (OM 24-049) as the “End/Discharge Date.” For members who do have other programs or records that need to be managed/maintained by the case management agency, but do not need the LTHH CSR assessment process tracked any longer, close the program card by updating the “Program Status” field to “Closed,” entering [effective date] (OM 24-049) in the “Program Closure Date” field, selecting “Other” in the “Reason for Program Closure” dropdown field, and documenting the reason in the “Other Closure Reason” field.
-
Q: Would members who are LTHH only need to be issued an NOA when we close the program card in the CCM? (11/26/24)
-
A: A Notice of Action (NOA) is not required as no action has been taken to reduce, deny, or change the member’s services, or deny functional eligibility for LTSS, you are just closing the program in the CCM as of the effective date (See OM 24-049), CMAs do not need to complete LTHH only LOC Screens.
| |
Newly Promulgated Rules for Case Management | |
|
Final Adoption by Consent
MSB 24-08-22-A Revision to the Medical Assistance Rule Concerning the Children's Habilitation Residential Program (CHRP) Waiver Eligibility Expansion, section 8.7100 to include Serious Emotional Disturbance (SED) within the CHRP targeting criteria for waiver eligibility.
Final Adoption
MSB 24-06-03-A Revision to the Medical Assistance Act Rule concerning At-Risk Diversion for Case Management Agencies, Section 8.7200
| |
Related Benefits & Services News | |
Upcoming CDASS & IHSS Q&A Open Forums | |
|
Consumer Direct for Colorado is hosting a Case Manager Open Forum webinar in January 2025 to answer questions about IHSS and CDASS. The Financial Management Services (FMS) providers, PPL and Palco, and HCPF will be participating.
Please join us to ask questions about CDASS or IHSS and to learn about upcoming changes to the programs. You can submit your questions in advance when you register online.
Case Manager Q&A Open Forum
When: Jan. 21, 2025, from 10 to 11:30 a.m.
Register here
Consumer Direct for Colorado will also host a member and Authorized Representative open forum event in February 2025. Please share this invite and information with the members or Authorized Representatives in your network.
Member and Authorized Representative Q&A Open Forum
When: Feb. 12, 2025, from 1 - 2:30 p.m.
Register here
| |
At-Risk Diversion Office Hours | |
|
At-Risk Diversion will offer additional support to Health First Colorado members living in the community who are identified by HCPF as At-Risk for Institutionalization through an internal model to be posted at a later time.
Office Hours will be scheduled to provide case managers with an opportunity to ask questions, provide feedback and seek out assistance. Case managers are encouraged but not required to attend office hours.
January Office Hours
When: Jan. 21, 2025, 9 to 10 a.m.
Register and join on Zoom.
Starting in February 2025, Office Hours will move to the third Tuesday of each month from 2 to 3 p.m.
Monthly Office Hours, beginning February 2025
When: Third Thursday of the month
Join with Google Meet or by phone: (US) +1 256-567-4801 (PIN: 600 066 368#)
Please email questions.
| |
Massage Therapy, Acupuncture, and Chiropractic Care Benefits Through the Complementary and Integrative Health (CIH) Waiver | |
|
Case managers may see increased interest from members on the Elderly, Blind, and Disabled (EBD) Waiver for massage therapy, acupuncture, and chiropractic care through the CIH Waiver. HCPF is working to increase eligible member's awareness of these services.
When a member you are working with asks about these services, please work with them to determine if the CIH Waiver and these health benefits would be a good fit for them and then complete their waiver transfer.
Why It Matters
Nine out of ten members using these services report meaningful improvements in:
- Daily pain levels
- Movement ability
- Overall quality of life
Provider Options
Members can choose from enrolled CIH providers. For those wanting to work with local providers not yet enrolled, the Chanda Center for Health and PALCO can assist with connections.
Resources
Find eligibility requirements, provider listings, and FAQs on the CIH Waiver Webpage and Long Term Services and Support Training site. To help with the waiver-to-waiver transfers, case managers should reference the job aids on Google Drive on the waiver-to-waiver transitions, opening a program card, and closing a program card.
Contact Kacey Wardle for technical assistance and support.
| |
Health First Colorado and Child Health Plan Plus (CHP+) Will Expand to Cover Children and Pregnant People Regardless of Immigration Status | |
|
Effective Jan. 1, 2025, Colorado children ages 18 and younger and pregnant people living in Colorado, no matter their immigration status, may obtain health coverage through Health First Colorado and CHP+.
These members will have access to full Health First Colorado and CHP+ benefits and may seek services from a provider without additional action needed by providers.
What does this mean for case managers?
Current processes for case managers will not change. Expectations and requirements for case managers are the same for these members as any other member.
The case manager impact is expected to be limited to a potential increase in patients seeking services. These new members may not speak English well or at all. Section 1557 of the Affordable Care Act requires any health programs or activities that receive federal funding to provide limited English proficiency (LEP) patients with a qualified interpreter.
Visit the Cover All Coloradans: Health Benefits for Children and Pregnant Persons web page for more information. Contact HCPF_CoverAllCO@state.co.us with any questions.
| |
|
HCPF held Rights Modifications training webinars on Dec. 9 and 11, 2024. Case managers can view the Rights Modification Training, webinar recording, and additional tools from this training posted on the LTSS Training Website. Before attending these Office Hours, case managers are encouraged to review:
HCPF is holding Office Hours sessions for case managers to discuss the Monitoring Guide scenario examples, additional questions, and member-specific situations. Registration is mandatory for anyone who wishes to attend these optional sessions.
Office Hours
When: Jan. 14, 2024, 1:30 to 3 p.m. and Jan. 23, 2023, 9 to 10:30 a.m.
Register and join on Zoom
| |
Resources for Identifying Group Employment Settings | |
|
Operational Memo 24-050 informs Home and Community-Based Services (HCBS) Medicaid- Supported Employment provider agencies, case management agencies (CMAs), and members of an operational update regarding the standards for determining when to utilize Supported Employment - Group services for members in the HCBS Developmental Disabilities (DD) Waiver, the Supported Living Services (SLS) Waiver, and the State SLS program.
OM 24-050 defines group employment settings and highlights Job Coaching - Group as the most appropriate service in those settings. It also specifies that Job Coaching - Individual services must not be authorized to support jobs that meet group employment criteria after February 1, 2025. Additionally, OM 24-050 indicates that Workplace Assistance may be used for members with elevated supervision needs in group settings if the member/situation meets the authorization criteria for Workplace Assistance. See OM 24-050 for specific definitions, dates, and authorization instructions.
Several tools are available to case managers, Supported Employment Providers, members, and others.
-
Group Employment Setting Guide and Tool - includes group employment service and setting descriptions and a series of questions to help determine whether a site meets the group employment setting criteria.
-
Workplace Assistance Service Guide - includes a service description and outlines what is needed prior to authorizing the service. The target audience for this tool is case management staff.
-
Workplace Assistance Authorization Request Tool - is to be completed by the Supported Employment provider to describe the member's job and situation. The tool should be shared with the member and their case manager. The case manager will determine whether Workplace Assistance is justified and will update their Person-Centered Support Plan as appropriate.
Contact Jenny Jordan for technical assistance and support.
| |
Statewide HCBS Procedure Code Changes Office Hours | |
|
Statewide HCBS Service Codes are changing beginning Jan. 1, 2025. Case managers must use the new HCBS service codes when adding services to PARs with service line start dates of Jan. 1, 2025, or later. HCPF will automatically revise all existing PAR lines impacted by these Standard HCBS code changes. Case managers may need to manually revise PARs if the units need to be adjusted on these PAR lines. HCBS providers should contact case managers if PAR revisions are required to adjust units based on service utilization. Please refer to the HCBS Fee Schedules on the Department Rates webpage for more information on these code changes. The HCBS Billing Manuals will be updated on the Billing Manuals webpage soon.
HCPF is hosting Office Hours to provide an opportunity for case management agencies to bring questions about these changes to HCPF staff.
Jan. 7, 2025, 2 to 3 p.m.
Register on Zoom
Jan. 9, 2025, 9 to 10 a.m.
Register on Zoom
| |
Informational Memo 24-035 - Update on Long Term Care and Buy-In Eligibility Extension | |
|
Long-Term Services and Supports (LTSS) Stabilization Eligibility Systems Updates
On Dec. 15, 2024, HCPF launched a new long-term solution aimed at providing members with additional time to manage their benefits. This solution will temporarily extend eligibility for Long-Term Care (LTC), Working Adults with Disabilities (WAwD), and Colorado's Buy-in for Working Adults with Disabilities (CBwD) programs for 60 days after the noted termination date.
This extension will apply to most termination reasons, not just procedural ones, allowing members extra time to submit their renewal packets and supporting documents. However, there are specific termination reasons that will not be eligible for this 60-day extension, which include:
- Death
- No longer a Colorado resident
- Withdrawal
- Incarceration (for secondary aid codes)
During this period, an initial letter will be sent to members informing them that their termination has been paused and explaining the reasons for this pause.
Additionally, HCPF will automatically re-evaluate eligibility in the second month of the extension. If a member meets all eligibility requirements and submits the necessary documentation, their ongoing eligibility will be approved. If they do not meet the requirements or fail to provide the required information, their eligibility will terminate at the end of the 60 days.
Before the end of this period, members will receive a formal Notice of Action that outlines whether they remain eligible or if their eligibility will end, along with information about their appeal rights.
The sunsetting of current protections in place will be phased in, starting with renewals in January 2025. This approach aims to support members and workers by managing smaller cohorts instead of sunsetting everyone at once.
If the eligibility worker manually updates the case, then the member may potentially terminate prior to their renewal date. These members will receive the 60-day extension mentioned above, but the member’s eligibility could end before their renewal date.
For questions, please contact hcpf_medicaid.eligibility@state.co.us.
| |
Member Correspondence Improvements | |
|
HCPF is holding a series of quarterly virtual stakeholder meetings to present information about ongoing improvements to member correspondence.
At the meetings, HCPF staff will share
- updates on improvements being made,
- timelines for making changes,
- plans for future letter improvements, and
- opportunities for stakeholders to stay involved.
In January, HCPF will provide updates and seek additional feedback on the renewal packet. Registered attendees will receive materials to review at least one week in advance of the meeting. Please come prepared to provide feedback.
Attendees will be able to submit questions to be answered live when possible. Frequently asked questions will be posted on the Member Correspondence Improvements website following the meeting. Attendees will also be able to submit feedback via Google form for two weeks following the meeting.
The meetings will be in English and Spanish. ASL interpretation will be provided.
Meeting dates and times:
- Thursday, Jan. 16, 2025, 12 to 1 p.m.
- Thursday, April 17, 2025, 12 to 1 p.m.
- Thursday, July 17, 2025, 12 to 1 p.m.
- Thursday, Oct. 16, 2025, 12 to 1 p.m.
Please register for the meetings in advance. After registering, you will receive a unique link to join the meeting.
For those who cannot attend the meetings, you may request a recording.
Meeting Accommodation and Language Access Notice: 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 the Stakeholder Engagement Section at HCPF_stakeholders@state.co.us at least one week prior to the meeting to make arrangements.
If you have general questions, please contact the Stakeholder Engagement Section at HCPF_stakeholders@state.co.us for more information.
| | | | |
