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| | New Case Management Related Memos | | |
Find all memos on the Memo Series web page.
OM 25-030 Community First Choice (CFC) Program Implementation (Supersedes OM 25-026)
Provides information on the CFC program effective July 1, 2025, and operational guidance to 1) Members enrolled in Health First Colorado on how to contact their CMA if they are interested, 2) Members enrolled in HCBS on the transition process, 3) CMAs on roles and responsibilities, training, the transition process, billing, and complaints, and 4) Provider Agencies on billing, rate adjustments, and licensing requirements for Personal Care.
OM 25-031 July 1, 2025, Consumer-Directed Attendant Support Services (CDASS) Rate Change
Provides information and operational guidance to Case Managers on the rate alignment of CDASS with CFC effective July 1, 2025.
OM 25-033 Pediatric Long-Term Home Health (LTHH) Prior Authorization Request (PAR) Therapy Go-Live
Provides operational guidance for the Pediatric LTHH PAR resumption period to Home Health Agencies effective July 1, 2025.
OM 25-034 Health First Colorado Children with Disabilities Buy-In (CBwD) 2025 Income Chart and Premium Guide
Provides income limit updates for Members in CBwD to Eligibility Sites.
IM 25-015 Billing Guidance for Individual Residential Services and Supports (IRSS)
Provides clarification regarding IRSS and IRSS/Host Home settings and subsequent reimbursement rates and billing for Provider Agencies and CMAs.
| | Case Management News: Questions and Answers | | |
Case Management Policy:
Q: What should case managers do when there is a delay in receiving financial eligibility at a member's Continued Stay Review (CSR)?
A: CBMS, CCM, interChange, and PEAKPro interface nightly; case managers must check the member's eligibility the next business day following the completion of the LOC Screen Reassessment to verify eligibility. If financial eligibility is not received within 48 hours of completing the LOC Screen Reassessment, the case manager shall report the delay to the CCM Support Center. If the issue cannot be resolved, the case manager shall escalate the delay to the eligibility site using the Health First Colorado and Child Health Plan Plus Grievance Form. A task will only generate for LOC Screen Reassessments when a member is not financially eligible (not applicable to PACE, which does not require financial eligibility) or if financial eligibility has not been received after 30 calendar days as outlined in the Streamline Eligibility Job Aid and Workflows and the System Generated Tasks Job Aid.
If the member's current Certification Period is nearing and financial eligibility has still not been received, case managers must mail an LTC NOA no less than 10 calendar days prior to the Certification End Date to deny the LTSS program for "not [having] an approved PAR in place at a minimum of 11 days prior to the certification start date". This provides the member with their right to appeal the action and ensures they have an avenue to receive continued benefits through the appeal period. This does not apply to a member going through the Intake and Enrollment process, as individuals have no appeal rights for services that have not already been authorized.
Q: Can Case Aids document Targeted Case Management (TCM) activities?
A: Maybe; Case Aids can complete the administrative task of documenting TCM activities on behalf of a case manager. However, Case Aids may not complete TCM activities unless they meet the case manager requirements outlined in §8.7203.A.3. Please note that while conducting the Level of Care (LOC) Screen is not a TCM activity, it must also be completed by a CMA staff member who meets the case manager requirements. Each CMA is responsible for developing job descriptions and hiring practices that ensure staff who are completing TCM activities meet the case manager requirements, regardless of job title.
Q: Can Provider Agency’s employees serve on a CMA’s Human Rights Committee (HRC)?
A: Maybe; 1.12.1. of the CMA Contract Version 2 states "an employee or board member of a provider agency within the CMA’s designated service area (DSA) shall not serve as a member of the HRC as outlined in", if the employee or board member of a provider agency is outside of the CMA's DSA they may serve as a member of the CMA's HRC.
Q: Where should case managers capture a member's supervision levels and which members require supervision levels to be outlined in Person-Centered Support Plan (PCSP)?
A: Supervision levels are to be captured on the Service Plan Form PDF for members enrolled in IDD waivers only, specifically for Residential and Day Habilitation services. Pages 3 through 8 of the service plan PDF are required to be included in the distribution packet of the PCSP to members and provider agencies as outlined in OM 25-025.
Q: Can you explain how HCBS works for members residing in Psychiatric Residential Treatment Facilities (PRTF)?
A: An individual cannot enroll in and access HCBS services until discharged from the PRTF. The CMA shall conduct the LOC Screen, receive financial approval, and conduct the PCSP, which includes selecting services and identifying provider agencies for enrollment into HCBS. If a member is currently enrolled in HCBS and is placed in a PRTF funded by Health First Colorado, the CMA shall not terminate the case as outlined in OM 25-027. In addition, members enrolled in HCBS residing in a PRTF cannot access HCBS services during their time of PRTF residency.
| | MSB Rules Affecting Case Management | | |
Medical Services Board Web Page
Final Adoption by Consent-Proposed Effective Date: August 14, 2025
MSB 25-01-09-A Revision to the exemptions as income or resource section 8.100.5.F.6 for the Aged, Blind, and Disabled, Long Term Care and Medicare Savings Plan programs, Section 8.100.5.f
The proposed rule change will amend 10 CCR 2505-10 8.100.5.F.6 to add compensation received for Medicaid Advisory Committee (MAC) & Beneficiary Advisory Council (BAC) participation, such as gift cards, to the list of exemptions from consideration as income or resources for the Aged, Blind, and Disabled, Long Term Care and Medicare Savings Plan programs. These changes are being implemented as an effort to encourage the participation of members in department surveys and initiatives that could be reimbursed through methods such as gift card awards. The change will prevent this compensation from resulting in impacts to financial eligibility for their programs. Changes will also include updating the reference of clients to be replaced with the word member or applicant/member.
Final Adoption-Proposed Effective Date: August 14, 2025
MSB 25-01-30-A Revision to the Medical Assistance Act concerning Private Duty Nursing Benefit Rule, Section 8.540
The purpose of this rule revision is to update two specific sections of the rules regarding the Private Duty Nursing (PDN) Benefit, to include language about the requirement of the Skilled Care Acuity Assessment and the role of the Nurse Assessor for state plan members who utilize benefits under PDN.
MSB 25-02-04-A Revision to the Medical Assistance Rule concerning Community Connector Services, Section 8.7514
This rule change is intended to limit inappropriate utilization of CCS to better align its realities with its initial goals and projections.
Initial Approval-Proposed Effective Date: August 30, 2025
MSB 24-12-09-A Revision to the Medical Assistance Rule concerning Money Follows the Person Rule, Section 8.555
The Environmental Adaptations (EA) rules are being updated to reflect the shift of payments for this MFP Supplemental Service to a contract. Additionally, several aspects of the MFP rules no longer apply to the EA program due to the differences between the Home Modification and EA programs.
MSB 25-02-07-A Revision to the Medical Assistance Act concerning Mobile Crisis Response Crisis Professional, Section 8.020.A-D
The purpose of this rule is to align with the Behavioral Health Administration (BHA) rules for Mobile Crisis Response by adding Crisis Professional requirements.
MSB 25-03-11-A Revision to the Medical Assistance Act Rule Concerning Secure Transportation – Crisis Professional
The purpose of the proposed rule is to change the term “skilled professional” to “crisis professional” in order to align with the Behavioral Health Administration’s (BHA) rules.
| | Related Benefits & Services News | | Required steps to identify Supported Living Program Tiered Rates for PETI | | |
HCPF’s third-party vendor, Telligen, has noticed several issues with case managers being unable to correctly identify the assigned tier level for SLP members. This email explains the interim process for case managers to use in identifying the assigned tier levels for members within the Care and Case Management System (CCM) before completing a member’s Post-Eligbility Treatment of Income (PETI) worksheet, along with the Prior Authorization (PAR).
Case managers are to follow the steps below:
- Go into the CCM and search for their SLP member.
- Review the “Activity Log” where Telligen’s notes are stored for the Member. The case manager will then identify the Telligen log inserted by April Kelly (Telligen). This log will contain the updated tier level information for SLP members.
Please note that within the “Activity Log” section in CCM, case managers can filter through logs reviewed by Telligen. Case managers may type the employee name “April Kelly” (Telligen staff) into the filter criteria. Once inputted, this should display the most recent logs, inserted by Telligen, reporting SLP tier level information.
This is the current process for case managers to identify SLP Tier Levels for members prior to completing the PETI/PAR process. Once HCPF has confirmed an alternative process to store this information in the CCM with Telligen, further communication will be provided to CMA’s.
Case managers may contact the CCM Support Center for assistance.
| | New Group Employment Setting Resources | | |
Operational Memo 24-050 defines group employment settings and highlights Job Coaching -Group as the most appropriate service in those settings. The memo addresses the
inappropriate use of Job Coaching - Individual in group settings by a small percentage of
providers. The memo specifies that Job Coaching - Individual services must not be authorized to support jobs that meet group employment criteria after Feb. 1, 2025.
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The Group Employment Setting Guide and Tool includes a series of questions to help determine whether a site meets the group employment setting criteria. The number of Waiver members working at a site and whether the Supported Employment Provider is also the entity that hires/fires/supervises etc., factors into whether it is a group employment setting or not.
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The new Meeting Discussion Guide: Group Employment Settings document is a companion guide for case managers. It identifies member options and specifies situations that need case manager action as it relates to Memo 24-05.
If you have questions or teams are struggling with identifying/navigating group employment settings, contact Jenny Jordan for technical assistance and support.
| | Updated Forms for Participant-Directed Programs (CDASS and IHSS) | | |
Updated forms for Consumer-Directed Attendant Support Services (CDASS) and In-Home Support Services (IHSS) are now available.
These revisions are part of our ongoing effort to ensure consistency, clarity, and compliance across all participant-directed service options. Please review and begin using the latest versions immediately to prevent processing delays or outdated documentation in member files.
Key updates include:
- Updated CDASS and IHSS Referral Form
- CDASS Attendant Support Management Plan (ASMP) for Community First Choice Members
- CDASS and IHSS Overview Flyers
- HMA Documentation Guide
To access the most current forms, visit the Consumer Direct for Colorado CDCO website.
Please remember to visit the CDCO website for the most up-to-date forms, rather than keeping a version on your desktop. Forms updated for members enrolling in Community First Choice (CFC) are forthcoming. If you have questions or need support, reach out to CDCO or the HCPF Participant-Directed Programs Unit at HCPF_PDP@state.co.us.
| | The Wellness Education Benefit (WEB) | | |
The Wellness Education Benefit (WEB) is a waiver service that provides short, educational articles that are mailed to Home and Community Based Services (HCBS) waivers on a monthly basis. The WEB is designed to reduce the need for a higher level of care by offering educational materials that provide HCBS waiver members and their families with actionable tools that can be used to increase community engagement, combat isolation, and improve awareness of Medicaid services. Additionally, the WEB acts as a monthly waiver service that helps members maintain their waiver eligibility.
With the launch of Community First Choice (CFC) on July 1, 2025 some Home and Community-Based Services (HCBS) waiver members may have all of their services move under CFC from their waiver when the member enrolls into CFC at their time of Continued Stay Review (CSR) throughout the transition year until June 30, 2026.
As you learned in CFC Case Management Training, to help members maintain their waiver eligibility, The Wellness Education Benefit (WEB) is available as a monthly waiver service. The WEB acts as a monthly waiver service, allowing members to maintain their waiver eligibility and continue accessing the services they need.
Talking to a member about the WEB and adding the WEB to your members’ PARs will prevent service disruption and help ensure continuity of care for all members. If you have any questions or need additional guidance, please contact the CFC team at HCPF_WEB@state.co.us.
| | Provide Feedback on 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, and
- plans for future letter improvements.
In addition to providing updates, attendees will have the opportunity to provide feedback on member letters in smaller workgroups. Registered attendees will receive materials to review at least one week in advance of the meeting. Please come prepared to provide feedback. 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, July 17, 2025, 12:00 to 1:30 p.m.
- Thursday, October 16, 2025, 12:00 to 1:30 p.m.
- Thursday, January 15, 2025, 12:00 to 1:30 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 Ryan Lazo 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.
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On August 15, 2025, the second list to CMAs will be distributed for the At-Risk pilot program, the list will consist of approximately 200 members statewide. As part of the contract requirements, CMs are asked to reach out to each member on the list within the required timeframe and ask them the prescribed At-Risk questions, complete necessary documentation, and refer them to supporting agencies as needed. It is encouraged that CMAs reach out and ask questions.
Ongoing Office Hours will allow Case Management Agencies to bring questions and provide feedback. Office hours are encouraged but not required.
Office Hours will be virtual via Zoom and will occur on the third Tuesday of each month from 2 to 3 p.m., register in advance here. These events can be found on the OCL Stakeholder Engagement Calendar.
Since April CMAs engaged in a Pilot Project survey to provide feedback, comments, and what type and level of information and/or training would be helpful to implement At-Risk Diversion successfully.
Here are preliminary results from the survey:
- Number of Respondents: 7
- Was there member impact as a result of the At-Risk outreach:
- 57.1% -No
- 14% -Yes
- 14.3% -N/A
- 14.3% -Unsure
- Additional Information and/or Training of following topics:
- 57.1 % - More information on At-Risk methodology (how members are identified)
- 57.1 % - More information on purpose and goals of At-Risk
- 42.9% - More information on DOJ updates
- 28.6% - More information on TCM-TC
- 28.6% - No additional Information/training
- 14.3% - More information on CCM documentation
- 14.3% - More information on HCPF website –regarding At-Risk
Visit the Keeping Coloradans in the Community and Out of Long-Term Institutionalization for more information. The In-Reach Team Project Feedback form is available to provide feedback, ask questions, and report issues and/or concerns outside of traditional meetings.
If you have questions or concerns, please do not hesitate to contact Victoria Lewis, HCPF In-Reach Coordinator.
| | ISLA Bridge Release: Important to Know | | |
The Interim Support Level Assessment (ISLA) is an assessment that will replace the Supports Intensity Scale (SIS) for new enrollments. It is designed to be similar to, but also an improvement upon, the SIS assessment of needs. It serves as a stepping stone toward full implementation of the Colorado Single Assessment (CSA), which will be automated in the CCM system. The ISLA Scale Scores and Support Level will replace the SIS Support Level as the resource allocation tool used in the Bridge for newly enrolling HCBS-DD and SLS waivers Members, effective July 1, 2025.
The ISLA Scale Scores and Support Level will be manually entered by the case manager and must not exceed two (2) digits and one (1) digit, respectively. A new ISLA tab, located within the Bridge, allows case managers to enter any Scale Score value (up to three (3) digits) and any Support Level (SL) value (up to three (3) digits) and save the entries without a system error occurring. Currently, the SIS SL only allows one (1) through six (6) SLs to populate in the Calculated SL fields, and the Scale Scores do not exceed fifty (50).
The Bridge system does not auto-populate the ISLA Support Level values, nor does it prevent entering invalid values. Therefore, it is possible that a Case Manager may enter an invalid or inappropriate ISLA Scale Score or Algorithm Level.
Case Managers must perform manual quality checks as they enter these values. It is essential that the case manager double-check the values. Once the PPA is created, it is expected that the values are correct. Users will not be able to submit the Pre Prior Authorization (PPA) if the ISLA Support Level does not match the service line items.
Questions about the ISLA policy should go to SIS_SL@state.co.us and systems questions about the Bridge should be directed to the CCMhelpdesk@gainwelltechnologies.com.
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