Case Management Redesign Frequently Asked Questions (FAQs) Available
The Department of Health Care Policy & Financing (Department) has posted a series of FAQs to the Case Management Redesign webpage to offer answers to common questions about the initiative. In the coming months, the Department will share these FAQs through this newsletter to inform case managers of the coming changes.
Q: Why is Case Management Redesign (CMRD) happening?
A: Single Entry Points (SEPs), Community Centered Boards (CCBs) and private Case Management Agencies currently provide case management for individuals with disabilities in the Department's ten Home and Community-Based Services (HCBS) waiver programs, with each serving different waiver programs.
In addition to case management services, many CMAs also provide direct services to program recipients, creating a conflict of interest which is no longer allowable by the Centers for Medicare and Medicaid Services (CMS).
Individuals who are seeking or receiving Long-Term Services and Supports (LTSS) often qualify for multiple programs and end up navigating between systems that are siloed by program, making the system difficult for members.
CMRD is intended to simplify access and remove silos so members will be able to 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 catchment area that is awarded by the Department through a competitive procurement process.
Further, these changes will meet the federal Conflict-Free Case Management requirement and allow the Department to ensure quality case management services for members across the state.
Q: Why is CMRD happening NOW?
A: In 2014, CMS, the Department’s federal partners, released as the requirements for the “Final HCBS Settings 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 must come into compliance with these rules by July 1, 2024.